TMA Gets Clarification on BCBST Mid-Level Provider Policy

April 11, 2017

TMA has spoken with BlueCross BlueShield of Tennessee about a policy that would prevent nurse practitioners and physician assistants from billing as a delegated service.

The policy was set to go into effect May 1, but implementation has been pushed out to allow BCBST to work with more providers.

Since September 2016, BCBST has included information in its monthly BlueAlerts about a new policy requiring all nurse practitioners and physician assistants to be credentialed and contracted before providing services to members. However, the March BlueAlert is the first one to let providers know that delegated billing will not be allowed.

TMA reached out to BCBST with questions about how this new policy will affect practices’ ability to bill under a physician’s NPI versus a nurse practitioner or physician assistant’s NPI, concerned that the new policy could lead to a reduction in some physicians’ overall reimbursement.

Currently all health plans, including BCBST, allow mid-level providers to bill for delegated services under the physician’s NPI. Under Medicare, this practice is known as “incident to” billing. Mid-level providers are usually reimbursed at a lower rate than the physician rate.

But BCBST has assured TMA that they do not plan to reduce reimbursement for group practices. If a mid-level provider is credentialed with BCBST and added to an existing group contract, reimbursement for services billed under the mid-level’s NPI would be the same as those billed under a physician’s NPI in the group. TMA will continue to make sure physician voices are heard as the policy is implemented, and will update members as more information becomes available.