Blue Cross Blue Shield of Michigan sends out audit notification letters Feb.28th
Dear MPTA Members and Interested PTs,
You may know that Blue Cross Blue Shield of Michigan (BCBSM) had sent out a repayment demand to 1,000 IPT's for an audit of claims from February 1, 2005 through September 30, 2006. These letters went out on February 28, 2007. The amount of repayment ranges from a few thousand dollars to $200,000 dollars. This is a big amount for any small practice; I am told it amounts to about $8 million.
The reason is a BCBSM "systems error" in which payments were made over the "cap". The biggest single source that I can find is MESSA, which has always paid charges once the out of pocket maximum is met. Many IPT's have tried to confirm this during this period and have reported to me that BCBSM provider inquiry has always said that the payment was correct. No one is alleging fraud or over utilization, however the amount demanded will put some people out of business.
The MPTA Reimbursement Relations Committee has been actively meeting with Blue Cross Blue Shield of Michigan (BCBSM) regarding these letters. Also, you should know that the MPTA was not advised of this problem at any time before the letters went out on February. 28, 2007.
MPTA regularly meets with BCBSM to identify issues, have open communication and improve the relationship of physical therapists to BCBSM.
Please contact the MPTA Office to obtain more information. Thank you for your cooperation and assistance in addressing this matter. If you know of member or nonmember physical therapists affected by the BCBSM payback notice, who can help us, and who are not already on our list of
affected PT's, you are invited to pass this notice on to them.
Please continue to email or contact the MPTA office if you would like to share any specific comments.
Peter V. Loubert PT, PhD
President, Michigan Physical Therapy Association
Mark D. Beissel,PT,DPT,OCS,FAAOMPT
MPTA Reimbursement Relations Committee Chair
MPTA Mission
The Michigan Physical Therapy Association is a professional organization representing physical therapists, physical therapist assistants and students who have joined together to assure that high ethical professional standards are maintained and that quality health care in the areas of prevention, education and rehabilitation of movement dysfunction and wellness are received for all consumers in the state of Michigan.
The Michigan Physical Therapy Association is a professional organization representing physical therapists, physical therapist assistants and students who have joined together to assure that high ethical professional standards are maintained and that quality health care in the areas of prevention, education and rehabilitation of movement dysfunction and wellness are received for all consumers in the state of Michigan.
Michigan Physical Therapy Association 3300 Washtenaw Avenue, Suite 220, Ann Arbor, Michigan 48104
Phone: (734) 929-6075 or (800) 242-8131 - Fax: (734) 677-2407 - E-mail: mpta@mpta.com
Phone: (734) 929-6075 or (800) 242-8131 - Fax: (734) 677-2407 - E-mail: mpta@mpta.com