Blue Cross Blue Shield Reimbursement Cuts Averted

4 Dec

December 4, 2018

Several Gastroenterologists and practice managers representing several practices and the AGS met on November 28 with administrators from BCBS of Alabama. We had the opportunity to express our thoughts and concerns on 3 major topics.

The first topic was the issue(s) surrounding the preauthorizations and hoops to jump through to get reimbursement for biologic therapy for IBD. The groups agreed that the current BCBS regulations were too stringent and that an advisory group of GIs and BCBS representatives would be formed to meet and recommend more reasonable guidelines.

The second topic was that of proposed reimbursement reductions for many of the endoscopic codes, especially the advanced procedure codes for EUS and ERCP. We were able to make multiple points highlighting the importance of these procedures and the importance of patient access to these procedures. The BCBS representatives were very receptive and seemed to recognize our concerns. They promised to revisit these proposed cuts and make a decision before the December 1 implementation date. I am happy to report that they did just that and we have received notice that the proposed reimbursement cuts for the EUS and ERCP codes have been cancelled.

The third topic was a discussion of possible overutilization of endoscopic services in the state. There appears to be no concern of overutilization by most GIs and the points were strongly made that non- endoscopic “screening” testing such as Cologuard, and CT colonography were inaccurate, not sensitive or specific, and were not substitutes for a complete colonoscopy by a well trained Gastroenterologist. Much of the overutilization of endoscopy comes from Internists or surgeons who have not had the level of training that a GI fellowship offers. These points were strongly made and again, the BCBS representatives promised to look into this further.

It appears that this was a useful dialogue which we plan to continue. Clearly, one thing that BCBS of Alabama responds to is the unified voice of the majority of gastroenterologists in the state. We have a larger voice which carries more weight the larger our organization is. We must make a concerted effort to have every GI in the state of Alabama to join the AGS so that negotiations like these, made by your representatives will carry the collective weight of all of the gastroenterologists in the state.

Thank you to all who supported and participated in this recent dialogue with BCBS of AL.

Kenneth M.Sigman, MD Vice President AGS