If you are working at or with an Ambulatory Surgery Center (ASC) in Illinois, you have more than likely come across the Blue Cross Blue Shield (BCBS) of IL Experience Report. And if you have come across it, you won’t soon forget it. BCBS’ payment structure and the complexity of the Experience Report, have been a common hang up with Illinois-based ASCs since its inception.
BCBS of IL has a different payment model than seemingly every other major insurance company. BCBS of IL issues payment for the entirety of the billed charges, less any calculated patient responsibility. Then, as stated in BCBSIL’s Provider Manual, “All contracted BCBSIL facility providers receive a monthly or quarterly Experience Report that lists all claims, accompanied by a cover letter that summarizes the figures for the year-to-date. The cover letter includes the repayment terms. The amount due must be paid within 30 days, unless providers participate in the Uniform Payment Program (UPP), in which case the amount due is deducted from the next month’s UPP checks.”
I’m sorry, what?
This means BCBS of IL will “takeback” the difference between your facility’s billed charges (less any calculated patient responsibility) and your contracted rate(s) with BCBS of IL.
The BCBS of IL payment model differs greatly from other payers in Illinois (IL) and elsewhere who simply issue payment for the amount(s) contracted with the facility. It also creates a necessity for facilities to develop new payment posting and accounts receivable (A/R) follow up practices in order to ensure they are being properly reimbursed in accordance with their contract.
in2itive has worked with several clients in the Illinois and greater-Chicago areas and has developed a specialized set of practices to accommodate the uniqueness of this payment model while ensuring our clients receive complete payment in accordance with their BCBS of IL Contract. Here are some tips you may find helpful if you are working with or at an ASC in Illinois. Note: some of the processes will need to be modified to accommodate your center’s billing system.
- Take contractual write offs at time of billing so you have an accurate depiction of what is owed to your facility on the patient ledger.
- When posting payments, post the amount owed by BCBS of IL to the appropriate CPT code and post the remainder (or the amount to be taken back) to unapplied. Note: Not all ASC billing softwares allow for this function.
- Review and post the remittance from your Experience Report promptly to allow for timely follow up of unpaid or underpaid claims.
- Track claims at the beginning of each calendar year. Historically, BCBS of IL does not update their rates internally until a few months into the new year.
- Know your BCBS of IL Experience Report ID Number and your contact person. General Customer service has not been able to address questions resulting from the Experience Report.
If your facility is struggling to accurately account for BCBS of IL charges, payments and take backs, you’re not alone. The modified payment structure generally creates additional effort on the part of the facility to ensure payments are issued in accordance with their contract. As with all payers, it is important to closely monitor such payments and promptly appeal incorrect or non-payments. If not, you’re likely leaving money on the table. For more information, or for help with your BCBS of IL Experience report, drop us a comment below.
Source: Blue Cross Blue Shield of Illinois. BCBSIL Provider Manual — December 2020. PDF File. February 23, 2021.