Blue Cross Reverses Policy to Discontinue Reimbursements for Medical Records Requests

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Blue Cross Reverses Policy to Discontinue Reimbursements for Medical Records Requests

Wednesday, June 24, 2015

On May 1, BCBSM announced it would no longer reimburse all-network physicians, hospitals or facilities for administrative costs related to medical records retrieval for risk adjustment purposes. Annually, Blue Cross and BCN requests medical records from providers to meet CMS standards for data submission and to review potential gaps in diagnosis coding. BCBSM has said that only a small percentage of providers request reimbursement for the administrative costs involved in the copying and faxing or mailing of risk adjustment-related records to Blue Cross. This did not affect reimbursement for medical records requests related to HEDIS.

On June 12, BCBSM rescinded its policy and will reimburse providers retrospectively back to May 1. MSMS and BCBSM heard from numerous practices regarding their concerns. MSMS spoke directly with Medicare Advantage staff, Provider Relations staff, the MSMS representatives to the BCBSM Board and presented at the May TriStaff meeting. MSMS is pleased that BCBSM reversed its decision to reimburse physicians for a portion of the cost of copying records for the plan.