Blue Cross Blue Shield’s Physician Group Incentive Program (PGIP) rewards physician organizations’ performance and best practices. The program is designed to improve the quality of patient care and reduce costs. Participating providers contractually agree to allocate a portion of their reimbursement to PGIP, and the allocation is used to fund the PGIP reward pool.
The PGIP allocation percentage has not increased since 2013. However, beginning July 1, 2018, the amount of professional fees allocated to the PGIP will increase from 5 percent to 7 percent. The increase will be used to fund new PGIP systems of care initiatives. The provider’s claims payment vouchers will reflect the increased percentage of the allowed amount, based on the applicable fee schedule.
According to Blue Cross Blue Shield of Michigan representatives, the Blue Cross PPO conversion factors will also increase by 2 percent, together with the PGIP allocation increase. Blue Cross Blue Shield of Michigan is focused on helping Organized Systems of Care (OSCs) to build the foundation for integrated care processes so that they can offer their patients more coordinated care.
The PGIP’s goal has always been to encourage and support providers in creating efficient systems for patient care. The amount of the reimbursement that goes toward developing these effective care practices and rewarding provider performance continues to increase. All PGIP incentive funds are distributed to participating providers to be used for these improvements; no funds are kept by Blue Cross.
For more information about PGIP, contact Yeo & Yeo Medical Billing & Consulting or refer to www.bcbsm.com/provider/value_partnerships/pgip.