Journal of Urgent Care Medicine

Your Antibiotic Stewardship Efforts Are Paying Off

A new study by the Blue Cross Blue Shield Association indicates that efforts to curb inappropriate antibiotics prescribing are working. The project considered 173 million claims reflecting the care of subscribers <65 years of age who filled antibiotic prescriptions between 2010 and 2016, finding that prescriptions for antibiotics fell 22% for infants, 16% for children, and 6% for adults during that time frame. Patients in the South and Appalachia were more likely to fill prescriptions …

Independence Blue Cross Slashes Reimbursements on Modifier 25

Independence Blue Cross has implemented a new policy that cuts reimbursements on procedures billed with modifier 25 (“Significant, separately identifiable E/M service”) by half for care given to Medicare Advantage members and patients covered by private insurance plans. The lower rate does not apply to traditional Medicare claims. Independence covers patients under its own name, but also through QCC Insurance Company, Keystone Health Plan Eastand AmeriHealth. The move sets Independence apart from other payers, including …

North Carolina Blues Throw Down the Gauntlet with Feds

Blue Cross and Blue Shield of North Carolinas (BCBSNC) says the federal government is trying to run out on a bill that amounts to $147.5 million in overdue risk-corridor payments. The Justice Department counters that the suit—along with several others that revolve around the 3-year-old program—is premature because any payments wouldn’t be due until next year at the earliest. BCBSNC is eager to have its day in court though, and says the government’s defense is …

Blue Cross Stakes a Claim in Urgent Care Startup

Blue Cross and Blue Shield of Minnesota sees a bright future for Livio Health Group, a new company that offers in-home urgent care and primary care services—so much so that it has invested an undisclosed amount to help the St. Paul, MN company increase its market presence. Livio sends clinicians to homes and other facilities to treat injuries and acute illness but also to help patients manage chronic conditions and offer diagnostic testing and preventative …