Contract Payment Review (CPR)
Are you sure that you are receiving all reimbursement due to your physician organization according to the terms of your payer contracts?
Many practices are confronted by constant payment errors, in many instances as much as 10% of submitted claims are not paid correctly. Today’s constantly changing healthcare environment results in providers 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. With no monthly service charge, no per provider cost, and no per report cost, MCAG delivers a recovery service that doesn't require significant investment on the hopes of finding lost dollars. 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.
CPR enables you to ensure 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.
MCAG Client Testimonial
Director, Business Development of large multi-specialty practice
“Our business has been using MCAG to perform payer reviews, provide benchmarking information, assist in payer contract negotiations, and other related services for our physicians for the past two years. They have demonstrated value for our organization by providing expert analysis, good communication and responsiveness. They have consistently exhibited their commitment to serving our needs, and they have delivered what we’ve asked of them. I am happy to recommend MCAG.”
Step 1: Data Acquisition and Modeling
- Gather your contracts and your electronic remittance data.
- Model contracts in our proprietary Contract and Fee Schedule Builder and analytics tool.
Step 2: Analysis
- 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.
Step 3: 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.
Service for a Contingent Fee
MCAG believes in aligning our incentives with your business goals. MCAG’s CPR Recovery Service utilizes a contingency fee based pricing model so we do not receive payment unless we recover revenue for your organization.
Contract Payment Review FAQ’s
- Review and analysis of claims and payment (or remittance) data to determine where underpayments have occurred
- Contract-level review of language and structure that are affecting your payments under each contract
- Identification of reimbursement trends by payer and root cause
- Implementation of recovery efforts for underpayments and other payment errors
- Recommendation of contractual changes by payer that will help reduce underpayments
- Maintains or improves payer relationships
- Delivery of a reporting package that demonstrates our program’s progress and meets your specialized needs via MCAG’s Client Portal
- Review, discuss and plan for your future needs
Market experience tells us that professional practices are underpaid, on average, 10% of their billed charges due to a variety of errors including payers reimbursing below the contracted reimbursement rate.
MCAG will prepare a specific work plan tailored to your organization’s needs. Our clients need to provide a project sponsor to be the point of contact and will help set up start-up activities such as the development of a communications plan for those people who will be involved with the project.
Prior to the implementation meeting, the project sponsor and/or staff members will be responsible for gathering:
- Practice/organization structure (tax IDs, locations, how billed, etc.)
- Payer contracts and related fee schedules
- Provider details (how they are billed, NPI numbers, etc.)
- Contact information (person(s) we should work with on your staff, their contact info, etc.)
- Information to allow MCAG to gather data (clearinghouse, format, transfer, etc.)
After the implementation meeting and the above discovery work is complete, we do virtually all the work with little disruption to the business office.
We offer our service on a contingency-based model, which is unique in the industry. No up-front investment is needed from our clients as we provide our service for a percentage of the payments that we recover on behalf of our clients.
The CPR Recovery Service is designed to complement what your billing company is currently doing – not compete with them, or their software.
While your billing company may be doing a front end scrub, it is very unlikely that they are checking the reimbursement with their contracts terms and fee schedules – the Contract Payment Review Recovery Service does.
Contract Payment Review is a service that is designed to complement any software that you may currently use – not compete with it.
We do not doubt that your organization does a wonderful job of getting reimbursed correctly by payers. However, you could probably do better with more staff – that’s why you should take advantage of CPR.
When conducting a review of payer activity, we check for overpayments as well as underpayments. Our clients can rest assured that this service is not exposing them to any future issues with the payers.
No, the focus is on commercial and managed care payers. Medicare and Medicaid payments are not included.
MCAG does not review denied claims from the payers. As part of the analysis, denied claims may be identified, but are not part of the MCAG recovery process. MCAG provides a full detail of all findings from our analysis to your designated practice point of contact.
- Legal name of client’s business
- Business address
- Signing authority (preferred but not mandatory)
- Tax IDs
- Number of providers (each with unique billing ID/NPI)
- Confirmation that client is receiving electronic claims AND remittances
- Clearinghouse(s) and dates used
- List of major commercial payers
- Approximate volume of payments per month
MCAG is willing to work with our clients to obtain the necessary payer contracts. We will utilize our expertise and knowledge of contracts and vast experience working with payers to assist our clients when confronted with this issue.
CPR is a full service recovery solution – that means that if you want your dedicated MCAG account team to submit and manage the appeals process they will. If you prefer a more hands on solution by your practice, you can use the MCAG generated reports and work with the payers yourself. Whichever approach you prefer, the MCAG account team is there to support you and work with the payers to collect on underpaid claims.
Hospital System in WI
Early Retiree Reinsurance Program
A Full Service Solution
From identification of problematic payers
to final resolution of incorrectly paid claims
we work with you from start to finish
A Dedicated Account Management Team
As a part of our full service
you are supported by
A Dedicated Account
that communicates with you
throughout the entire process
Service for a Contingent Fee
We believe in aligning our incentives with your business goals. MCAG's Recovery Services utilize a contingency fee based pricing model so we do not receive payment unless we recover revenue for our clients.
Clarification of Complex Reimbursement Rules
Our in-depth evaluation
of your contracts and fee schedules
clarifies complex reimbursement rules
to ensure your practice is paid according to
the payer contract
MCAG's CPR Recovery Service
Integrates seamlessly with your
existing practice management tools
and day-to-day staff workload
Continuous monitoring of payer appeals
ensures the full corrected payment is achieved.
This continuous monitoring provides a direct
financial improvement to the practice’s bottom-line
MCAG works directly with
your practice to appeal
contractually underpaid claims
to the payer