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Payer Audit Solutions
Audit and Appeal Management - Professional Billing
Through MCAG Audit Solutions, you can be confident
that you're receiving full reimbursement for every insurance claim you file.
This uniquely complete, integrated service uncovers underpaid claims, produces
validated appeals and manages the recovery process until you receive fair
payment. With virtually turnkey ease, Through MCAG Audit Solutions collects your claims, compares
them to your contracts and fee schedules, and takes into account your rights
under HMO settlement actions and industry coding standards. Our unique
combination of legal insight and coding experience has earned us an unparalleled
record of success in collecting on underpaid claims for medical providers.
Audit Review and Appeal Management - Facility/Inpatient Billing
Medical facilities are subject to a slew of rules and regulations that
can make tracking billing and payments a complex and frustrating affair.
Research demonstrates that even the most diligent, conscientious providers lose
up to 10% of their revenue through underpaid claims. MCAG Audit Solutions uncover instances of underpayment so you can direct those funds
where they truly belong – straight to your bottom line.
Payer Compliance Audit
An ongoing series of HMO settlement actions has, in recent years,
created many opportunities for medical providers to recover funds they were
unfairly denied. But it's also placed unprecedented stress on medical office
staffs, who struggle to understand and properly apply the wide-ranging, specific
terms of each settlement. MCAG Audit Solutions reviews the payments its clients receive
from HMO payers to ensure that they're getting the benefit of every legal
requirement -- and all of the hard-won rights -- these settlements have returned
to the medical community. We also manage the appeal and recovery process for our
clients, providing the expertise that allows them to spend more time providing
their own expertise to the patients in their practices.