Physician incentive component to increase for most codes

Effective July 1, 2013, the Physician Group Incentive Program physician organization reward component of professional fees will increase to 5.0 percent for most procedure codes, except those for durable medical equipment, prosthetics and orthotics, anesthesia, immunizations, hearing, vision and most injections.

The current physician organization component used to fund the incentive program is 4.7 percent.

Our innovative physician incentive program rewards performance and best practices, and is designed to improve the quality of patient care while helping to reduce costs.

Here’s what you will see on your claims payment vouchers. BCBSM pays the physician the approved amount that is based on our established fee schedule.

At the same time, the voucher shows an additional physician organization component amount (5.0 percent) for PGIP incentives, which is available to PGIP POs. These are dollars exclusively devoted to the PGIP incentive pool and are not intended as fee schedule reimbursement. The dollars are not taken out of the approved amount that is paid to the health care provider.

Combined, they add up to the allowable amount. The allowable amount is our way of tracking — on an individual claim basis — the separate amounts we spend on physician reimbursement and PGIP. All funds from the PGIP incentive pool are distributed to the PGIP physician organizations to support physician practice transformation. No money is retained by BCBSM for administrative costs.

Note: Claims for Federal Employee Program^® members are excluded from the Physician Group Incentive Program.

For more information on the Physician Group Incentive Program, please contact your provider consultant. You can also find information about PGIP at bcbsm.com/provider/value_partnerships/pgip.