Medicare AdvantageReimbursementHigh impact
Payment policy updates
Blue Cross Blue Shield of Rhode Island·RI · Emergency Medicine·Physician / Facility
Effective date
Jan 1, 2025
We identified it
Jun 19, 2026
Summary
BCBSRI implemented three major billing changes: Medicare Advantage telemedicine visits will have in-office cost sharing starting January 1, 2025; COVID-19 vaccine cost share waivers have ended; and emergency department E/M coding will face new review criteria with potential downgrades or denials for inappropriate levels.
Action Required
By January 1, 2025: Update patient cost sharing calculations for Medicare Advantage telemedicine visits to match in-office rates. Immediately: Stop waiving COVID-19 vaccine cost sharing and bill patients accordingly. For emergency departments: Review E/M coding practices for levels 1-5 to ensure appropriate resource utilization documentation, as BCBSRI will audit based on presenting problem, diagnostic services, and complications. Prepare appeal processes for potential E/M code downgrades.