Mystery still exists in billing codes

House leaders on Wednesday removed a provision that would have required hospitals to make public some price information from a health care information technology bill (HR 4157), CQ Today reports (Crowley, CQ Today, 7/26). The legislation, sponsored by Reps. Nancy Johnson (R-Conn.) and Nathan Deal (R-Ga.), would codify the Office of the National Coordinator for Health Information Technology within HHS and would establish a committee to make recommendations on national standards for medical data storage and develop a permanent structure to govern national interoperability standards. The bill also would clarify that current medical privacy laws apply to data stored or transmitted electronically and would require the HHS secretary to recommend to Congress a privacy standard to reconcile differences in federal and state laws. Under the bill, the number of billing codes health care providers use to file insurance claims would increase from 24,000 to more than 200,000 by Oct. 1, 2009 (American Health Line, 6/8).

In addition, the legislation would provide grants of about $30 million for the implementation of electronic health record systems. According to CQ Today, the "price transparency" provision, supported by conservative lawmakers as part of an effort to "make the health care marketplace more amenable" to health savings accounts, "angered the hospital industry, which lobbied lawmakers to take it out of the bill." Some lawmakers also criticized the provision because the measure did not appear in versions of the bill passed in June by the House Ways and Means and Energy and Commerce committees. The removal of the provision "is likely to help smooth passage of the bill ... when it comes to the floor Thursday," CQ Today reports (CQ Today, 7/26). One House leader on Wednesday said that the legislation likely will pass (O'Connor et al., The Hill, 7/27).

To help control rising health care costs, Blue Cross and Blue Shield of Illinois (BCBSIL) has contracted with American Imaging Management (AIM) to implement a statewide utilization management and quality improvement program of high-tech outpatient diagnostic imaging services. Beginning April 3, a Radiology Quality Initiative (RQI) program will be implemented for elective, outpatient, high-tech imaging services - MRI, PET, CT, Magnetic Resonance Angiography (MRA) Scans and Nuclear Cardiology - for all members, except HMO, residing in Illinois and Lake County, Indiana.

The RQI program promotes appropriate ordering of outpatient diagnostic imaging services based upon the member's diagnosis, while minimizing unnecessary radiation exposure.
What does this mean?Effective for dates of service on or after April 15, 2006, all non-emergency imaging services listed above, when performed in a physician's office, outpatient department of a hospital or a freestanding imaging facility will require an RQI number.
How RQI WorksPhysicians ordering an imaging exam for the elective high-tech services must contact AIM prior to scheduling. The recommended service is evaluated to determine the appropriateness according to diagnosis. AIM will also direct the ordering physician to a contracting network provider as needed.

AIM will provide a consultative service to physicians, helping them select the most appropriate radiological service for their patients. Although physicians' orders will go through AIM's clinical review process, no denials will be given and no medical necessity decision will be rendered. The RQI process will be transparent to members.

Contact AIMOrdering physicians can obtain and imaging service providers can confirm a patient's RQI number either online; www.americanimaging.net or by calling AIM's RQI Department toll-free at 1-866-455-8415 Monday through Friday, 8:30 a.m. to 6:00 p.m. (CST).

Note: issuance of an RQI number is not a guarantee of payment. The claim will be processed in accordance with the terms of the subscriber's health benefit plan.
Physician Training AIM and BCBSIL are currently providing extensive training for physicians on the RQI processes, along with a guidebook including program instructions and contact information. Additionally, training schedules for the RQI Program are currently available on our web site at www.bcbsil.com.

For more information about BCBSIL health plans please visit www.medequote.com

Blue Care Connection Program

Blue Care Connection provides personalized attention, support, online resources and health advocacy to help you find the right resources, optimize your health care benefits and manage medical conditions.

Utilization and Case Management – These programs are supported by health care professionals, including doctors and nurses who can help you understand your benefits and identify health care resources.

Mental Health and Chemical Dependency – Behavioral health professionals help you find doctors for mental health and chemical dependency management and certify inpatient or partial hospitalization.

Care Advisor – A registered nurse can assist you with questions about chronic conditions and coordinate care, providing you with a single point of contact.

Personal Health Resources – Numerous online tools help you manage your overall health care. You can create a personal health record to keep track of personal health information. You have access to online health content to research health topics.

Healthy Expectations™ – This program helps pregnant members and their babies get off to a healthy start by providing educational materials and support including pregnancy risk assessment and monitoring.

For more information visit www.medequote.com

Blue Edge HSA from BCBSIL

BlueEdge plans are easy to understand and use. With BlueEdge, you’ll enjoy seamless claims integration and decision-making tools that help you manage your health care benefit needs as well as your budget. BCBSIL provides integrated consumer-centered services that help you understand your health care choices.

BlueEdge plans include coverage for adult and child Preventive Care and Wellness visits that help you stay healthy.

Spending Account funds can be used to pay for health care expenses. Eligible expenses will count toward your deductible.

Online Resources include innovative, easy-to-use online tools to help you manage your health care and your health care spending. These useful tools will help you budget health care expenses, keep track of your Spending Account, review costs for common health services, research and compare hospitals in your area, find a network doctor and learn more about making wise decisions to stay healthy and fit.

Many of our BlueEdge plans include PPO benefits. When you receive care from doctors in your network, benefits are paid at the highest level and you have fewer out-of-pocket costs.

For more information on Blue Edge HSA's from BCBSIL, or any other Illinois HSA product please give us a call at 800-391-7469, or visit our website at www.medequote.com

BCBSIL introduces new discount hearing aid program

All members of a Blue Cross and Blue Shield of Illinois group health plan now have access to a discount program which allows them to purchase digital hearing aids at a substantially reduced price. This program is available through an arrangement with TruHearing*, a company with a national network of more than 1,200 hearing care professionals. This discount program is available to members and their covered dependents, as well as parents and grandparents.

Features of the TruHearing program include:

Free hearing screening when performed for the purpose of fitting a hearing instrument
Selection of hearing aid styles at different price levels
45-day money back guarantee
2-year warranty

To learn more about the TruHearing program, find a location or schedule a hearing test, Blue Cross and Blue Shield of Illinois members can call (866) 687-2020 toll free.

Blue Cross Blue Shield of Illinois health plans are available at www.medequote.com

*The relationship between Blue Cross and Blue Shield of Illinois and TruHearing is that of independent contractors.

BCBSIL offering more web insurance management tools

Companies that are best at controlling healthcare costs are more likely than their poorer performing counterparts to offer multifaceted Internet tools that help employees model healthcare options, a study by Watson Wyatt and the National Business Group on Health has found.A majority (58%) of the 585 companies surveyed provide Internet resources that allow employees to compare healthcare insurance options side by side, but companies that are best at controlling costs offer additional Web tools. They are 38% more likely to provide quality comparison tools and 36% more likely to provide tools to model the tax impact of healthcare decisions, such as signing up for a flexible spending account. In addition, while only a small number of companies offer Internet resources for provider pricing, those best at controlling costs are 108% more likely to do so."The Web can be a great help in effectively delivering healthcare information to employees and is especially important for companies making significant plan design changes," said John Berkowitz, of www.medequote.com. "Companies adopting a consumerism approach to healthcare are finding that employees need more than financial incentives to become better healthcare consumers - they need information as well. Tools that allow employees to consider many facets of their healthcare can make a significant difference in the healthcare options employees choose."Although many companies are providing Web resources that help employees model their healthcare options, most are not yet offering the information on provider quality and pricing that employees need to make more cost-effective choices."Providing information on the cost-effectiveness of providers is key to directing employees to lower-cost, higher-quality healthcare," Berkowitz said. "Employers can harness the Internet to help provide this data and encourage employees to use healthcare providers with the best treatment outcomes." Companies like BCBSIL - Blue Cross Blue Shiled of Illinois who are making strides to bringing these tools to the internet should be congratulated.

www.medequote.com

BCBSIL unveils an electronic application

The states largest health provider recently unveiled an electronic application process which speeds up underwriting tremendously. Until recently the application process at BCBSIL was very cumbesome and time consuming. We had to tell our clients that wanted the product that it would take up to six weeks to be accepted. For most that was unacceptable.
With the new electronic application we are able to turn around applications within a week without using the old paper method. That saves a lot of time and is great for the consumer.
BCBSIL also continues to be almost the only, and best option for couples seeking maternity coverage from an individual/family policy. The rates are reasonable, approximately $100-$150 more per month depending on where you live. Assurant also offers maternity but it can be quite expensive. When shopping maternity please understand that it is not included in your policy unless offered as a rider. Please be aware that most companies do not offer full maternity, beware of partial maternity riders from association companies that are almost worthless. Another thing to be aware of is waiting periods for conception. There is no such thing as immediate maternity coverage for individuals. True groups however have no waiting period.

www.medequote.com

BCBSIL Emergency Room Benefit

One of the outstanding features of most BCBSIL health insurance plans is the superior emergency room benefit that is offered. All ER services are paid at 100% with no deductible, or copay which makes it an ideal addition to any family plan.

Most plans don't offer such comprehensive coverage for ER benefits, most apply the visit toward your yearly deductible. Some competitors offer an accident only ER rider where you can have additional coverage of up to $1000 for an ER visit but that does not compare with the benefit provided by BCBSIL.

Health plans are like shoes, one size, or style doesn't fit all, but at www.medequote.com you can pick from up six or seven different companies, and every possible plan design available. We proudly feature health plans from BCBSIL, UniCare, Assurant, Celtic, World and Humana. We want to make sure you have choice, plus the ability to easily compare all the health plans in your area. What is considered great in Chicago may not be the best fit in Peoria, Rockford...etc... .