The Record

Here’s what you need to know about the proposed ambulance purchased services program and how to provide feedback

Blue Cross Blue Shield of Michigan is proposing the implementation of an ambulance purchased services program. This program will include ambulance services from the originating facility to another facility and then return to the originating facility in the purchased services definition. Program implementation is scheduled for fourth quarter 2024, for Blue Cross commercial and Blue Care Network commercial.

Ambulance transports will be added to the purchased services definition found in the Participating Hospital Agreement Payment Manual.

Current PHA Payment Manual 23.0

Future PHA Payment Manual 24.0

Purchased service definition:

Services obtained from another hospital or freestanding facility, usually because the admitting hospital does not have the necessary equipment and/or skilled personnel available to provide the service. Purchased services generally include, but are not limited to, CT-scans, MRIs, ESWLs, angiograms, arteriograms, cardiac catheterization and Doppler services.

Future purchased service definition:

Services obtained from another entity including a hospital or freestanding facility, usually because the admitting hospital does not have the necessary equipment and/or skilled personnel available to provide the service. Purchased services generally include, but are not limited to, CT-scans, ambulance transports, MRIs, ESWLs, angiograms, arteriograms, cardiac catheterization and Doppler services.

What this means to facilities

Facilities reimbursed by DRG or per diem will be responsible for the cost of any ambulance transport from their originating hospital to another facility and then returning to their originating facility.

Example: Patient is admitted to facility A and needs an open MRI, but facility A doesn't have the equipment. Patient is transported by ambulance to facility B for the procedure. The patient is then transported back to facility A by ambulance. Facility A will be responsible for the transport costs in addition to the purchased services.

Ambulance services will be subject to the PHA Payment Manual’s "Purchased Services" section 5.4:

Only the hospital with the inpatient admission may bill for services provided to that patient during the inpatient stay. Payment for purchased services is as follows:

Inpatient:

Hospitals subject to DRG and per diem reimbursement: The facility cost of purchased services has been included in the DRG price or per diem price. Blue Cross will not make additional payment for these services.
Percent of charge reimbursed hospitals: Purchased services charges may be billed by the hospital as part of the inpatient claim.

Outpatient:

Purchased services are payable to the provider performing the service.

Input requested

According to the Contract Administration Process — part of the Participating Hospital Agreement that went into effect July 1, 2021 — we allow non-binding input from participating facilities about such proposals.

Input from facilities is requested by June 30, 2024. Send any input you may have to Lauren Rossi at LRossi2@bcbsm.com.

After input is received, Blue Cross has 30 calendar days to respond to input.

No portion of this publication may be copied without the express written permission of Blue Cross Blue Shield of Michigan, except that BCBSM participating health care providers may make copies for their personal use. In no event may any portion of this publication be copied or reprinted and used for commercial purposes by any party other than BCBSM.

*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2023 American Medical Association. All rights reserved.