Please click on the following link for more information:  BCBS Drug Update (2.15.2012)

January 6, 2012

Beaumont Health System, Blue Cross Blue Shield of Michigan and Blue Care Network
Reach Agreement on Reimbursement Contract

Blue Cross Blue Shield of Michigan, Blue Care Network and Beaumont Health System signed a new contract late Thursday that keeps Beaumont Health System in the hospital network used by Blue Care Network hospital network, increases reimbursement to the health system and institutes new performance-based standards for paying the health system in the future.

Daniel J. Loepp, Blues president and CEO said,

“This agreement is a win-win – not for the health system or the insurer – but for our members and customers. It maintains access to Beaumont facilities for our customers and members. It commits Beaumont, Blue Cross and physicians to work together to achieve high-quality health care and the efficient use of health care dollars. It advances our efforts to deliver innovation in how Michigan pays for health care in the future.”

The five-year agreement provides an increase in base reimbursement to Beaumont Health System while also committing Beaumont to a new performance-based hospital payment model sought by the Blues. Under the new model, Beaumont will work closely with its affiliated physician organizations and the Blues to design standards for successful patient health outcomes that will be the basis for part of its reimbursement.

The new contract moves away from the traditional fee-for-service payment approach toward an outcomes-based approach that revolutionizes the ways hospitals are paid. The new pay-for-performance contract terms sought by the Blues and achieved in this agreement represent a new standard for how Michigan hospitals are paid for services, and how the Blues can help hospitals and physician organizations build efficient and coordinated systems of care.

The agreement includes an opportunity for infrastructure improvements needed to better integrate care services between Beaumont and its physicians groups. The performance standards that will be mutually determined by Beaumont and the Blues will financially reward the hospital for maintaining better overall population health and ensuring the efficient use of tests and procedures.

In December the Blues announced that St. John Providence Health System (SJPHS), and its five acute care hospitals across southeast Michigan, was the first health system in the state to partner with the Blues on a new performance-based reimbursement model. Both the new Beaumont contract and the agreement with the St. John Providence System signal a new era in health care that rewards hospitals for keeping patients healthy and out of the hospital.

We extend thanks to our agents, groups and members for their patience during the contract negotiations. We recognize that some may have felt caught in the middle and may have been inconvenienced. We apologize for the uncertainty the situation has caused. We value the relationships we have with our customers and agents.

Release from Blue Cross Blue Shield/Blue Care Network

December 19, 2011

January bills released, clarification of Michigan Claims Tax on billing statements

January BCBSM and BCN bills and invoices have been mailed to group customers. As communicated earlier, these bills and invoices now include the new Michigan Claims Tax.

We have worked hard to determine the best way to report to our customers about the claims tax and help them clearly understand the new state tax liability. To achieve this, we made the following billing adjustments.

MOS bills and invoices
While we have provided the new tax as a separate line item on the summary page, on the detailed page we’ve changed the Total Charge column to reflect both the premium and tax. This change ensures the accuracy of the bill or invoice when membership changes are made – especially with customer refunds.

Customers that are still on the local billing system will not see this change until they are migrated to the MOS system.

We’ve illustrated how both the summary and detailed charges are reported in paper (PDF) and eBilling ( PDF) examples.

Tax calculation on Local and MOS bills
For groups on the local billing system, the tax assessment for January and February will be calculated based on current charges. This will ensure we do not include taxes on any 2011 membership adjustments. Starting in March, the tax assessment will be based on total billed to accommodate 2012 membership adjustments.

For groups on the MOS billing system, the tax assessment will be calculated based on current charges and membership adjustments starting with the January 2012 bill. Any 2011 membership adjustments will not be subject or calculated into the tax assessment.

Questions? Please contact your Salus Group agent at (866) 991-9907. ]]> http://www.thesalusgroup.com/bcbsbcn-jan-bills-released-with-mi-claims-tax/feed/ 0 http://www.thesalusgroup.com/649/ http://www.thesalusgroup.com/649/#comments Thu, 08 Dec 2011 13:09:22 +0000 bfazzolara http://www.thesalusgroup.com/?p=649 Read More]]>

On September 20, 2011, Governor Rick Snyder signed into law the Health Insurance Claims Assessment Act, S.B. 348, which will impose a new one percent (1%) tax on paid health care claims.

This tax, which takes effect on January 1, 2012, will be paid by insurers that provide fully-insured plans, and by third party claims administrators in the case of self-funded plans. The tax is intended to help fund Michigan’s Medicaid program, and will be paid quarterly, beginning April 30, 2012.

This one percent tax replaces the current six percent use tax applied to Medicaid managed care plan services, which state officials believe could jeopardize federal funding for Medicaid under Health Care Reform.

While all insured Michigan residents will be impacted by this new legislation, it remains unclear how insurers will reflect the additional cost in their statements. At this time, we understand that Blue Cross Blue Shield of Michigan will include it as a line item on member bills, but other carriers may opt to build the tax into their rates.

The new tax applies to most health care claims, but not all. According to the statute, some of the exempt claims include:

• Services for Michigan residents received outside of the state

• Cost-sharing requirements (deductibles, copays and coinsurance)

• Reimbursements under a flexible spending arrangement, health savings account, Archer medical savings account, Medicare Advantage medical savings account or other health reimbursement arrangements authorized under federal law

• Claims paid under a federal employee health benefit program

• Medicare, Medicare Advantage, Medicare Part D claims

• TRICARE (military-CHAMPUS and the United States Veterans Administration claims)

• Workers’ compensation and long-term care claims

The tax is intended to generate $400 million in annual revenues for the state of Michigan. If the revenue collected exceeds that amount, insurers and third party administrators would receive a credit against their assessments due the next year. Barring any legislative intervention, the tax is set to expire January 1, 2014.

Other states have similar taxes.

If you have any questions, please contact your Salus Group representative at (866) 991-9907. We will continue to keep you updated as more details are announced.

Please review the official announcement, the sample letter that will accompany the check and FAQ page.

BCN Official Announcement

BCN Sample Letter

BCN Refund FAQ

4th Quarter 2011 – BCBSM lower increases