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Blue Cross Cuts for Physical Therapy – Payment Algorithms Changing to Flat Fee of $75 No Matter What the Level or Duration

Posted Feb 22 2010 9:28am

Unlike the premium increases, this goes into effect March 1st, and as we all know physical therapy is different for different types of issues/disabilities/diseases.  imageMost physical therapists won’t drop Blue Cross due to the fact that they can’t afford to, but compensation will be less.  What is happening here now is that less attention will be given to a patient as just like the HMO’s had to do, it’s now a picture of volume, seeing patients every 15 minutes, no brain surgeon required to figure this one out.  If you check out the link below, there’s additional information about the 3rd party companies who also provide business intelligence services to health insurance companies to “score” and create some “behavioral” data projections that also impact payment of medical claims, so all if this may not be done in house by your insurance carrier. 

So it appears the company sees physical therapy for a broken thumb along the same lines as rehabilitation for cardiac issues?  One more change in the algorithms used to calculate compensation.  Remember as I have said before, these payment processes with most carriers are highly automated so there’s not an individual looking over each case, the algorithms do all of this with electronic processing and it takes IT individuals to change this with programming, so here again it’s a matter of a programming change within their system that will allocate compensation, get to know how algorithms work and how it could affect you.    BD

Anthem Blue Cross drew ire from President Obama on down this month after informing individual policy holders of premium increases of up to 39 percent. But physical therapists are also upset over cuts in reimbursement for Blue Cross patients.

Beginning March 1, Blue Cross will pay physical therapists $75 per visit for all treatment, regardless of the duration or type of care provided. The California Physical Therapy Association says PTs will loss as much as 50 percent of their previous fees.

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