UHC September Monthly Overview

BCBS RSV Vaccine Update

Sept. 1, 2023

RSV Vaccine Coverage Update
Applies to all non-grandfathered groups

Beginning Sept. 1, 2023, we will cover the Respiratory Syncytial Virus (RSV) vaccine without cost sharing for adults, as recommended by the Advisory Committee on Immunization Practices (ACIP).

What you need to know:
  • This year, the Food and Drug Administration (FDA) approved two new RSV vaccines, Abrysvo and Arexvy, for the prevention of lower respiratory tract disease caused by RSV in those age 60 and older.
     
  • We will cover both RSV vaccines without cost sharing when obtained at a doctor’s office (as a medical claim) or at a participating pharmacy (as a pharmacy claim) for groups that have Prime® Therapeutics as their Pharmacy Benefits Manager (PBM).
     
  • Groups that have carved-out pharmacy benefits should check with their PBM to confirm their coverage and implementation of this update.
     
  • As with any preventive service, the vaccine must be obtained from an in-network provider to be covered without cost sharing.
     
  • This coverage update is effective Sept. 1, regardless of renewal date for all non-grandfathered ACA-compliant plans.

Note: The RSV vaccine for infants (Beyfortus) is a different drug and is covered under the medical plan only.

Blue Cross and Blue Shield of Texas (BCBSTX) contracts with Prime Therapeutics to provide pharmacy benefit management and related other services. BCBSTX, as well as several independent Blue Cross and Blue Shield Plans, has an ownership interest in Prime Therapeutics. MyPrime.com is an online resource offered by Prime Therapeutics.

7 Ways to Ease Collections

Collecting money from patients is an ongoing challenge that has only worsened with high-deductible health plans. Traditionally, physicians have accepted this challenge as the status quo, instead choosing to overlook unpaid balances and provide the care that patients need. However, experts say the COVID-19 pandemic has prompted them to rethink this strategy and take a more proactive, business-savvy approach.

Patient collections: A complex issue

 “Medical practices are really in a lot of trouble right now — especially independent primary care practices — because of lower reimbursement,” says Rozmin Bapat, CCS-P, CPB, CPC, CPCO, CPMA, president of CodeRite Healthcare Consulting. “A lot of doctors are asking patients to pay up front. Sending statements is a big cost drain on their revenue.”

Still, asking for payment and receiving it are two different things. Asking is, of course, the first step; however, practices also need to address this major barrier: Patients don’t understand their health insurance benefits, including what they owe and, more importantly, why.

“What we’ve seen is that office staff are not trained properly,” says Bapat. “They can’t explain the bill, and it leads to more patient frustration.”

Another layer of complexity? The Wall Street Journal reported earlier this year that certain credit-reporting firms have already started to remove medical debt that consumers pay after their bill goes to collections—debt that can sometimes remain on a credit report for up to seven years. Starting in 2023, some credit-reporting firms will also remove unpaid medical debt of less than $500. Asking patients to pay their medical bill may become more difficult when there are fewer financial consequences.

Patient collection strategies for success

Experts provide the following strategies to ease the burden of patient collections and improve cashflow and revenue.

Looking ahead

Experts agree that now is the time to improve the patient collections process. “Health care organizations need to compensate staff, invest in new technology, and support the services they offer to patients,” says Hutson. “Reimbursement for health care services is essential to sustaining high quality care to the communities they serve.”

Salary and Benefit Survey

We all need a little help from time to time.

            When hiring, reviewing payroll, or adjusting pay scale, it is helpful to know the “going rates.”

            You search the internet to find some great information.

            However, the information is usually Houston, Dallas or Fort Worth based.

            Yet, we all know Metroplex never looks like Rural.

This is where we need to join together and be a help to each other.

            We ask you to please print the salary survey. Fill out as much as you feel comfortable with. Then you may fax or e-mail it to POET. If you would like to remain completely anonymous, mail it to 111 Gaslight Blvd, Ste. B, Lufkin, Tx 75904.

            Your participation is important. With many offices facing the current weight of hiring, they are also looking for the local pay range. POET receives requests for local salary ranges. However, we do not have this information, unless it is provided by our members.

            Again-you can participate anonymously by returning the survey by mail.          

            Please, help relieve the burden of stress for so many Office Managers and Administrators.

Staff Reviews, we all hate them

The opportunity for these meetings to go well is just a few measurements away. Whether it is front-desk, back-office, or healthcare staff, making sure that you have measurable goals and metrics will ensure these meetings are successful.

This article from Physicians Practice has some great pointers. Check it out by clicking the link below.

Cigna Network News 3rd Quarter 2023

Claim status notifications available on the CignaforHCP.com Message Center

7 Tips to Combat Embezzlement

BCBS Pharmacy Quarterly Update

Health Plan Representatives Update 8/3/2023

The Health Plan Representative List has been updated. Feel free to download and keep a copy in all the areas where it is needed.

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