RBRVS and allowable fee schedule annual updates    
The BCBSNM maximum allowable fee schedule uses certain aspects of the Medicare Resource Based Relative Value System (RBRVS) methodology. BCBSNM has traditionally updated the maximum allowable fee schedule to the current year RBRVS relative value units (RVUs) annually.

As previously communicated in our April 2011 letter sent to providers, BCBSNM has evaluated CMS’s decision to implement a decrease in the RBRVS conversion factor with a concurrent increase to certain RVUs. BCBSNM has made the decision not to convert to the 2011 CMS RVUs and flat fees. However, new codes will continue to be added to the system and the average sale price for injectable drugs will be updated quarterly.

Therefore, current reimbursement rates will continue to be calculated using the 2010 RVUs that became effective July 1, 2010, and contractual conversion factors will remain as specified in your current Medical Services Entity Agreement.

If you have any questions or concerns, please contact the Network Services Department at 800-567-8540 or (505) 837-8800.


Blue Review • August 2011 • bcbsnm.com