BCBSNM is witnessing an increase in the number of physicians who have changed their practice model to that of a concierge, or boutique, practice. In this model, patients are charged a fee, typically annually, in exchange for "premium service." Often the fee is charged for administrative reasons, such as filling out forms or to offset rising malpractice insurance premiums.
The methodology utilized by Blue Cross and Blue Shield of New Mexico (BCBSNM) in its fee-for-service reimbursement is based on the CMS Resource-Based Relative Value Scale (RBRVS). Specifically, BCBSNM's payment incorporates the CMS Relative Value Units (RVUs) which reflect the physician's work, practice expenses, and professional liability insurance costs. These RVU components are developed by CMS and include input from major medical specialty societies.
BCBSNM's fee-for-service reimbursement rates take into account all of the factors mentioned above. Therefore, for reasons of member equity, BCBSNM has made a business decision not to contract with providers who charge retainers or annual fees to BCBSNM members.
Contracted providers who are charging these fees will be sent written notice advising them that BCBSNM members must be excluded from the fees in order to maintain their BCBSNM contracts.
Contact our provider representatives at 505-837-8800 or 1-800-567-8540 for any questions.
