Last Updated: Jan 25, 2018
Independence Blue Cross (IBC) announced a two-part policy change regarding the credentialing and reimbursement of office-based pathology services.
Effective Jan. 1, 2018, IBC’s pathology provider network is now closed to new office-based pathology providers. Pathologists can no longer be added to participating non-pathology practices. An exception was made for pathology providers who join an existing participating hospital-based pathology group in a participating hospital.
Effective April 1, 2018, IBC will also prohibit billing and reimbursement for pathology services provided by office-based pathologists. Claims submitted after April 1, 2018, will be denied.
The Pennsylvania Medical Society (PAMED) sent an email to IBC regarding the recent changes. On Jan. 24, 2018, IBC sent a response letter with these answers:
- Will there be an opportunity for practices that already employ pathologists and are currently reimbursed for their services, to be grandfathered in?
“Independence will not grandfather current in-office pathology providers, as these providers are performing the same services that our network laboratories already perform.”
- With physician office labs no longer be able to bill for their own services starting April 1, 2018, what should these practices do?
“Starting April 1, 2018, specimens should be sent to an Independence in-network, participating laboratory for processing and reading (e.g., Laboratory Corporation of America® Holdings [LabCorp]).”
- Does Independence have a list of preferred reference labs that will handle pathology orders?
“Yes. A list of LabCorp sites can be found at: www.ibx.com/individuals/find_provider/laboratory_provider.html.”
- Is place-of-service code 11 (physician office) the only affected place of service?
“Yes. Office-based pathology services in place-of-service code 11 will no longer be paid. No other place-of-service codes will be impacted.”
- Can you specifically identify which plans this applies to, for example: Healthcare.gov exchange plans, employer-based plans, Medicare Advantage, or Medicaid, or others?
“These changes apply to all commercial and Medicare Advantage lines of business.”
This issue will be on the agenda for the Feb. 6 PAMED Specialty Leadership Cabinet Meeting. Stay tuned for updates in the Dose and on PAMED’s website.
Additional information can be found on IBC’s Provider News Center here. PAMED members with specific questions can contact our Knowledge Center at 855-PAMED4U (855-726-3348).