Posted in BCBS Empire NY, Training, Updates

BCBS NY: Reimbursement Policies Updates for 2021

1.Reimbursement Policy: Consultations (Professional)

Effective 10/31/2021- Empire BCBS policy “Documentation and Reporting Guidelines for Consultations” policy will be renamed as “Consultations” Please remember that this policy will be updated to align with CMS guidance- DOES NOT ALLOW reimbursement for inpatient (99251-99255) or outpatient (99241-99245) consultation codes and requires providers to bill the appropriate office visit Evaluation and Management (E&M) code for consultation services

To read this full reimbursement policy, please click here.

2. NEW Reimbursement Policy (facility): Non-patient Laboratory Services

Effective 10/01/2021- Empire BCBS will implement a new reimbursement policy- Non-Patient Laboratory Services. This policy states that Empire does not allow reimbursement for non-patient laboratory services when reported on a UB-04 with bill type 014X unless provider, state, federal or CMS and/or requirements indicate otherwise

To read this full reimbursement policy, please click here.

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My name is Kate Patskovska, CPB. I am an Independent Medical Biller CPB (AAPC) and an owner of KR2 Medical Billing. KR2 Medical Billing is a full service Consulting/Medical Billing Business that is dedicated to educating, consulting, and overall improving the "financial health" of your medical practice.

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