Contract Payment Review Consulting
The U.S. healthcare landscape is undergoing massive change through public and private exchanges, Medicaid expansion and new accountable care models. Complex reimbursement structures and shifts towards value-based reimbursement models are complicating the way hospitals and physicians are paid for services. Each year, it is estimated that hospitals are underpaid between 1-5% of Net Patient Revenue. These underpaid services translate to millions of dollars that could hit the bottom line of your healthcare system.
As today’s healthcare environment continues to evolve, many providers are needing to do more with less. As a result, having enough resources to successfully pursue a remedy for incorrect payments is more difficult every day. MCAG understands the direct impact of these realities and has created solutions to help providers avoid losses in revenue that are the result of incorrectly paid claims.
MCAG’s Contract Payment Review (CPR) Recovery Service changes the way providers and practices think about monitoring payer reimbursement. We deliver our recovery services on a contingent or fee-for-service basis. Unlike other payment review software tools that require clients to load their own contracts and fee schedules, perform analysis reports, and appeal findings with payers themselves, MCAG brings a total service solution to providers that frees up staff time so that it can be focused elsewhere.
Our CPR services ensures that reimbursements received from payers meet negotiated and contracted reimbursement rates. We utilize our superior systems coupled with a highly experienced, professional team to help our clients recoup money from insurance payers attributed to underpayments and contract errors.
We work with limited support from your staff to determine root cause analysis on issues identified and actionable recommendations to decrease future concerns. We also work with our clients to help fix any identified compliance or quality issues in their billing systems.
Our Three-Step Process
Gather your contracts and your electronic remittance data.
Model contracts in our proprietary Contract and Fee Schedule Builder and analytics tool.
Identify and validate underpayments and payment errors utilizing our proven technical and professional expertise.
Provide analytics and reporting to clients via MCAG’s client portal.
APPEALS AND RECOVERY
We work with our clients on a best approach for submitting appeals to payers and/or negotiate with them.
Whether you negotiate with your payers or MCAG negotiates on your behalf, our goal is to recover your correct reimbursement.