Metropolitan Chicago Healthcare Council
Strategic Reimbursement Enters into Agreement with Metropolitan Chicago Healthcare Council to Market SRI’s Blue Cross Payment Review Service
Rolling Meadows, February 17 -- Strategic Reimbursement and the Metropolitan Chicago Healthcare Council, a membership and service association comprising more than 140 hospitals and health care organizations, today signed an agreement whereby MCHC will administer and market SRI’s Blue Cross Blue Shield of Illinois Managed Care Compliance/Recoupment Program to hospitals throughout the state of Illinois.
This program, designed to help ensure hospitals receive full and proper reimbursement, from Illinois Blue Cross includes the following features:
- A retrospective review of account and payment activity
- The identification of both "under" and "over" payments
- The recovery and tracking of "under" payments
- Specialized staff education and training
- No cost assessment review
- Contingency based fee
Despite being one of the largest payors in Illinois, Blue Cross presents a unique set of challenges all their own. Unlike other managed care payors, Blue Cross’s policy of adjudicating claims at 100% of covered charges and then “taking back” a portion months later does not allow hospitals to compare the payments received through the normal billing/accounts receivable process. In addition, Blue Cross’s UPP system and Experience Reports present other potential issues related to contractual allowances and preparation of the annual Blue Cross Cost Report. This system typically produces errors, many of which go against the hospital.
"Strategic Reimbursement has over 30 years of experience working with hospitals on a variety of reimbursement issues," said Robert Gienko, President of Strategic Reimbursement. "We are very excited to be working with such a prestigious organization as the Metropolitan Chicago Healthcare Council to help ensure Illinois hospitals receive the proper reimbursement from one of their largest payors, Blue Cross Blue Shield."
"MCHC's mission is to improve the delivery of health care services in the Chicago area," said David Hey, CFO of MCHC. "Strategic Reimbursement’s Blue Cross Payment Review Service is a proven method for Illinois hospitals to determine and receive their proper reimbursement amounts from Blue Cross. Having reviewed other competing products, MCHC determined that SRI’s approach was the most thorough and accurate. We believe it will be in the best interest for all Chicago hospitals to participate in this program."
Strategic Reimbursement has been actively assisting hospitals across Illinois receive full reimbursement from Blue Cross Blue Shield since 1994, identifying millions of dollars in underpayments. They are skilled in the Blue Cross managed care payment process and enjoy a strong and close professional working relationship with BCBS of Illinois.
About Strategic Reimbursement
Strategic Reimbursement is an employee-owned consulting firm focused exclusively on third party compliance, reimbursement and revenue enhancement for hospitals and other healthcare providers across the country. Founded in 1975, our firm has assisted over 400 hospitals and systems with their most serious reimbursement issues with a variety of payers including Medicare, Medicaid, Tricare/CHAMPUS and managed care.
About the Metropolitan Chicago Healthcare Council
MCHC is a membership and service association comprising more than 140 hospitals and health care organizations working together, since 1935, to improve the delivery of health care services in the Chicago area. The Council's Institutional members consist of hospitals (and their integrated delivery systems) in the eight-county Chicago area. Associate members include hospitals outside these counties, as well as physician groups, nursing homes, outpatient treatment centers, insurers, medical schools and other health care organizations. MCHC's Board of Directors acts as the policy-making body for the organization and assesses MCHC's progress in addressing health care-related issues.
