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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. 



Drug Spend Review