New reimbursement policy: Provider Preventable Conditions – Professional and Facility

Empire BlueCross BlueShield (Empire) recognizes the importance of addressing provider preventable conditions for our members and, as a result, has adopted an enterprise-wide focus on patient safety. To facilitate this effort, we have started reaching out to providers when a hospital acquired condition or major surgical never event has been identified.

Beginning with dates of service on or after September 1, 2023, Empire will expand the current Preventable Adverse Events – Facility reimbursement policy as follows:

• In addition to facility providers, the policy will now be applied to professional providers
• The policy will address Empire–defined provider preventable conditions (PPC)

The policy will be retitled Provider Preventable Conditions – Professional and Facility, and the Preventable Adverse Events – Facility reimbursement policy will be retired.

For specific policy details, visit the reimbursement policy page at https://providerpublic.mybcbswny.com.