The new deadline for response is May 23.

The change is a direct result of a meeting between the TMA board and Dr. Robert Mandel, BCBST Sr. VP, Health Care Services. TMA members should watch for more information from BlueCross BlueShield of Tennessee (BCBST).

The amendments affect your contracted fee schedule for Networks P and S and are time sensitive, with your response due by May 23.

Physicians have three options:

1. Accept the amendment in writing on or before May 23;

2. Take no action, in which case the amendments will be deemed accepted; or

3. Reject the amendments in writing, in which case BCBST has the option of terminating you from the networks

Background

The letter accompanying the amendments indicates that your current fee schedule is linked to CMS methodology for Medicare reimbursement. When CMS tinkers with its reimbursement formula, it affects your BCBST reimbursement. The letter outlines two previous years where CMS adjustments to RVU or GPCI factors have resulted in physician reimbursement increases for physicians. On April 1, 2011, another CMS adjustment resulted in a payment increase that averaged six percent for physicians. The letter states that BCBST cannot pass the six-percent increase on to its customers.

The effects of these amendments, if you accept them, will be:

You will receive, on average, a six-percent increase until June 23, 2011On June 23, your reimbursement rate will revert to last year's rate (the rate effective on March 31, 2011)If CMS adjustments to its reimbursement methodology result in Medicare reimbursement increases or decreases in the future, your BCBST Network S and P reimbursement rate may remain at the rate in effect on March 31, 2011

TMA members should already have received the letter with contract amendments. If not, you should contact your BCBST provider representative or local BCBST office immediately. Again, this is time-sensitive material.

The TMA cannot advise members as to whether to accept or reject the BCBST contract amendments. Each practice must carefully evaluate how the amendments would affect your bottom line and decide whether to accept the amendment or try to negotiate an alternative if you have leverage due to specialty or location.

For more information, contact the TMA Legal Department at 800-659-1862.

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