Blue Cross Pricing/Coding
David Hendricks
Description
Collection
Title:
Blue Cross Pricing/Coding
Creator:
David Hendricks
Date:
3/16/2006
Text:
Dear Orthotic Colleagues:
I have a customer with what I hope is an unusual problem. He would like to use a product of ours which SADMERC has given a code with a fair reimbursement (L0627, for which Medicare allows $332.72 in this customer's state), but he does a lot of BCBS work.
That code crosswalked from K0636, for which BCBS allowed $349.35, but for the new code, L0627, they allow only $88! An obvious mistake, right? A clerical error, probably? Well, he contacted his ombudsman, presented the problem, and this is the reply he got, verbatim:
Carey hi, Thank you for bringing up this issue, however, our pricing team reviewed the new code pricing before we added the code to our DME fee schedule. We feel this code is price correctly.
Thank you.
My customer is asking for my help. I'd like to help. What can I do? Who would you contact? This is an outrageous situation, as there are almost no orthoses approved by SADMERC for this code that sell to the orthotist for less than the $88 BCBS allows! (Ours is an exception, but it's just $11 less, hardly enough to sustain a profitable practice!
Any advice would be appreciated. I want to help my customer. I'm willing to write, call, email; beg, plead, reason ... but I don't know to whom it would be effective.
Regards.
David
David Hendricks, CPO, FAAOP
<Email Address Redacted>
HOPE Orthopedic
6439 Milner Blvd.
Orlando, FL 32809
ph: 800-613-8852
fax: 888-440-1217
ph: 407-850-0411
fax: 407-851-8922
I have a customer with what I hope is an unusual problem. He would like to use a product of ours which SADMERC has given a code with a fair reimbursement (L0627, for which Medicare allows $332.72 in this customer's state), but he does a lot of BCBS work.
That code crosswalked from K0636, for which BCBS allowed $349.35, but for the new code, L0627, they allow only $88! An obvious mistake, right? A clerical error, probably? Well, he contacted his ombudsman, presented the problem, and this is the reply he got, verbatim:
Carey hi, Thank you for bringing up this issue, however, our pricing team reviewed the new code pricing before we added the code to our DME fee schedule. We feel this code is price correctly.
Thank you.
My customer is asking for my help. I'd like to help. What can I do? Who would you contact? This is an outrageous situation, as there are almost no orthoses approved by SADMERC for this code that sell to the orthotist for less than the $88 BCBS allows! (Ours is an exception, but it's just $11 less, hardly enough to sustain a profitable practice!
Any advice would be appreciated. I want to help my customer. I'm willing to write, call, email; beg, plead, reason ... but I don't know to whom it would be effective.
Regards.
David
David Hendricks, CPO, FAAOP
<Email Address Redacted>
HOPE Orthopedic
6439 Milner Blvd.
Orlando, FL 32809
ph: 800-613-8852
fax: 888-440-1217
ph: 407-850-0411
fax: 407-851-8922
Citation
David Hendricks, “Blue Cross Pricing/Coding,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 17, 2024, https://library.drfop.org/items/show/226317.
