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Blue Cross Blue Shield of Minnesota's controversial site-of-service policy — 3 key takeaways

Blue Cross Blue Shield of Minnesota's site-of-service policy change can benefit patients by driving them to lower-cost settings, according to healthcare expert Archelle Georgiou, MD, who was interviewed by KSTP

Three insights:

1. Blue Cross Blue Shield of Minnesota stopped reimbursing hospitals for seven forms of upper and lower gastrointestinal endoscopy for commercially insured members as of March 4. The insurer will only pay for GI endoscopies and colonoscopies if they're performed in an ASC, unless there isn't an ASC within 25 miles.

2. The policy could benefit patients because facility fees are significantly higher at HOPDs than ASCs, Dr. Georgiou said in her interview with KSTP. Patients who haven't met their deductible yet will see those facility fees affect their bottom lines, she said.

She highlighted the difference in facility fees with two examples:

Endoscopy facility fee

ASC: $392
HOPD: $761

Colonoscopy with a biopsy

ASC: $504
HOPD: $979

3. Support for the policy is far from ubiquitous. In late July, the Minnesota Hospital Association asked state officials to investigate Blue Cross Blue Shield of Minnesota, contending the site-of-service policy is illegal.

Vachette Pathology, a management consulting firm in Sylvania, Ohio, also weighed in. "This obviously is having a major impact on pathologists in the state who routinely perform these services and is a situation we are continuing to monitor for revisions or updates," the organization wrote on LinkedIn.

More articles on coding, billing and collections:
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Optimizing medical billing and collections — 4 strategies 

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