Alert: BlueCross BlueShield Of Tennessee Incorrectly Recouped Payments

August 3, 2022

Nashville, TN — A member medical practice recently notified TMA that BlueCross BlueShield Of Tennessee (BCBST) recouped payments based on an audit that may extend before the policy was effective. Practices receiving recoupment demands from BCBST based on denied HCPC codes G0101 or Q0091 which were billed with certain E&M codes for dates of service prior to Nov. 1, 2021, should check the policy and consider appealing the recoupments.

Background: Effective Nov. 1, 2021, BCBST updated its Evaluation and Management Policy for Gynecologic Screening services billed with Preventative Medicine visits or annual exams. Since then, BCBST has not allowed HCPC codes G0101 or Q0091 to be billed with preventative services, including 99384-99387, 99394-99397 or an annual screening HCPC codes S0610-S0612. If these codes are billed together, Q0091 and G0101 will be denied. TMA is concerned about recoupment demands for payments before the policy was effective and urges practices to double check audit results if they receive recoupments based on any of these payments.

TMA contacted BCBST regarding the audit, and it advised that physicians’ remedies are to appeal these recoupments. It did not relay plans to review the audit methodology.

If your practice has questions or needs guidance, please contact Tabitha Lara, TMA’s Director of Insurance Affairs, at 615.460.1651 or tabitha.lara@tnmed.org.