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Hospital-Blue Cross stalemate moves toward resolve

Kimber Wraalstad
Kimber Wraalstad

Blue Cross Blue Shield of Minnesota has altered its plans to change its payment methodology.  Lori Nelson, Blue Cross Vice President, contacted Cook County North Shore Hospital administrator Kimber Wraalstad yesterday. Wraalstad told WTIP the adjustments will apply to all rural critical access hospitals.

Blue Cross had originally scheduled major payment changes to smaller hospitals on May 1. Implementation of the new system has now been moved to January 1. Individual hospitals have negotiated contracts with Blue Cross for how they are reimbursed and at what rates. The insurer had proposed major changes to those contracts.

Wraalstad said Blue Cross will assist hospitals in obtaining the 3M Grouper software and pay for ½ of the software costs for one year. The softwear provides a coding mechanism hospitals use to bill Blue Cross for reimbursements. The Minnesota Hospital Association maintained the May 1 change over was too soon to accommodate adopting the complex coding system.

In addition, Wraalstad said “Blue Cross will develop some type of process or ‘safety net’ for critical access hospitals with insufficient operating margins to cover the cost of Blue Cross commercial members.”

She added at this time, neither Blue Cross nor the hospital will be proceeding with termination as an Institutional Service Provider. Wraalstad had received a service termination letter from Blue Cross late last week.

On Monday, the Department of Health Commissioner Ed Ehlinger and Attorney General Lori Swanson, met individually with Blue Cross executives to discuss the issue.

Wraalstad said, “We are appreciative that Michael Guyette, Blue Cross CEO, and his Executive Management team are willing to participate in negotiations so that the community members and visitors to Cook County will continue to have access to services at Cook County North Shore Hospital and Care Center.”