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Timed Codes Calculations: BCBSIL Update

Tuesday, August 13, 2019   (1 Comments)
Posted by: Matthew Nicholas
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Timed Codes Calculations: BCBSIL Update

Governor Pritzker signed SB 653 into law on June 22, 2019 and BCBSIL worked quickly to implement changes to the calculation of timed codes to comply. Clinical payment coding verbiage on their website is in the process of being updated and should be completed this week.

Communications with BCBSIL have indicated that Cotiviti's (previously Verscend) clinical validation of claims with -59 modifiers will continue and still include NCCI edits but calculation and payment of timed codes is now based on AMA standards. An inactivation process is still in place for those that meet thresholds through clinical validation. Inactivation is done monthly and BCBSIL anticipates that, since a great number of providers were billing according to AMA standards, many providers will be inactivated in the next couple of months.

BCBS acknowledged that the bill was signed into law, effective immediately, on June 22nd but the change in claims processing happened on June 24th. They plan to internally review all claims processed during that window of time to ensure that all claims were processed according to AMA calculation of timed codes.

It is important that providers document and bill services correctly. If documentation does not support units billed (i.e. documentation shows 3-5 minutes billed as a full unit), the unit will be denied.

Please let us know if you note an issues arising during this time of transition so that we track and communicate concerns to BCBSIL.





Jon R. Frohning PT DPT ATC says...
Posted Wednesday, August 14, 2019
Does this mean that all BCBS patients should be billed for time based codes for PT services following Medicare Guidelines?

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