BUSINESS

Georgia doctors wait for CPT code bundling info

The state medical association wants Blue Cross and Blue Shield of Georgia to hand over fee schedule information.

By Robert Kazel, AMNews staff. April 7, 2003.

With feelings both of frustration and déjà vu, the Medical Assn. of Georgia is asking a judge and the state's insurance commissioner to force Blue Cross and Blue Shield of Georgia to give physicians information on how it bundles CPT codes for patient claims -- the same data the association says the court ordered the Blues to reveal almost a year ago.

The medical association is accusing the Blues, owned by California-based WellPoint Health Networks, of failing to comply fully with a judicial order handed down in 2002 by the Superior Court of Fulton County. The court had told the insurer to supply physicians with its fee schedules.

It did, but the association is arguing that much of that information is useless if physicians aren't also provided details on how base fees are altered by the Blues plan's bundling software.

"They admit they do this but refuse to admit how they do it," said David Cook, executive director of the physician group.

The dispute stems from a lawsuit filed in 1997 by the medical association and four doctors, asking the court to declare that all physicians' Blues contracts were unenforceable because doctors in the state had no way of knowing how much they eventually would be reimbursed. Without that knowledge, the association argued, "consideration" -- a key ingredient of contracting that allows each side to know exactly what it is giving and getting in a transaction -- didn't genuinely exist.

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