Blue Cross updates requirements for specialist fee uplifts

Effective Feb. 1, 2016, anesthesiologists participating in the Physician Group Incentive Program will be eligible for specialist fee uplifts. All other specialist physicians, podiatrists, chiropractors and fully licensed psychologists in PGIP are currently eligible for specialist fee uplifts.

Here are the criteria practitioners must meet in order to be considered for a specialist fee uplift in 2016:

• Practitioners must be a member of a PGIP physician organization for at least one year (that is, the practitioner must be on both the PGIP practitioner list “snapshots” taken on July 1, 2014, and June 30, 2015). This is a new requirement designed to ensure that practitioners are fully engaged with their PGIP physician organization prior to nomination for a specialist fee uplift. Anesthesiologist will be exempt from this requirement for the 2016 fee uplifts. However, anesthesiologists must be a member of a PGIP physician organization and be nominated by the member PO by June 30, 2015, to be considered for a 2016 fee uplift.
• At least one physician organization (and, in some cases, two POs) must nominate the specialist practice.
• Once nominated, specialist practices must meet population-level performance metrics and thresholds developed by Blue Cross Blue Shield of Michigan.

Physician organizations can nominate specialist practices that:

• Include at least one practitioner from the eligible specialties
• Have displayed a high level of engagement with the physician organization
• Are actively involved in managing and optimizing the use of services and quality of care
• Are partnering with primary care physicians to improve care processes and coordination
• Have signed their PO’s primary care-specialist agreement

Nominations for the specialist fee uplifts will occur between April 20, 2015, through June 29, 2015.

Nomination by a physician organization does not guarantee that a practice will be selected for a specialist fee uplift.

Selected practices will receive the fee uplift for one year — from Feb. 1, 2016, through Jan. 31, 2017. The nomination and selection process are repeated annually.

The specialist fee uplifts currently apply to the Relative Value Units-based procedure codes. Any revisions or updates to these codes will be published in future editions of The Record.

For more information, contact your provider consultant.