CPRvista: A clear and actionable view for revenue recovery
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 providers are underpaid between 1-5% of Net Patient Revenue. These underpaid services translate to millions of dollars.
Your organization works hard to secure the most favorable contract rates for the services you provide. Unfortunately, even when a claim is coded correctly, payers often find ways to underpay or deny claims. Returned claims must be reviewed on a line-by-line basis to identify if each code was accepted, and if so, what amount was paid. This puts a heavy burden on your billing staff to not only produce accurate bills, but also re-examine the Explanation of Benefits (EOB) or Electronic Remittance Advice (ERA) from payers to verify that bills are resolved properly.
MCAG's CPRvista is the most comprehensive tool available today for analyzing remittance data to identify and recover under allowed payments. It analyzes paid claims line-by-line and reports on payments at variance with your most recently contracted rates. It identifies and classifies under allowed, under billed and denied claims, while helping you recover revenue to which you are contractually entitled.
CPRvista changes the way providers and practices think about monitoring payer reimbursement. We deliver our analytics dashboard and advisory services in return for a monthly subscription and our recovery services on a contingent fee 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.
We work with limited support from your staff to determine root cause analysis on issues identified and provide actionable recommendations to decrease future concerns. We continue to run this analysis on a monthly basis for you to capture all underpayments on an ongoing basis. This will help ensure that your organization is getting every dollar is has earned. 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 analyze under allowed and under billed payment errors and denied claims utilizing our proven technical and professional expertise.
Provide analytics and reporting to clients via the CPRvista Dashboard.
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.