Contract Expert Enforces Payor Contracts & Increases Revenue 7%
Payment errors cost U.S. medical groups billions of dollars annually. A $2,000,000 practice typically loses $140,000 a year on claims paid at less than the contract rate. Practice management systems cannot correct this because they are not designed to identify or track contractual payment errors. Solving this problem requires a practice-specific payor contract knowledge base which can value the services performed according to the complex terms of today’s healthcare contracts. MDeverywhere solves this problem and puts medical practices back in control of their contracts. The steps MDeverywhere takes to recover this lost money are:
- Contract definition and modeling: An MDeverywhere contract analyst reviews the practice’s payor contracts and builds a knowledge base that is practice specific. This knowledge base includes the contracted payments and all payment rules including service carve-outs, global fee periods, multiple surgery reductions, modifier multiples, code edits, site-of-service payment adjustments and private payment rules.
- Continuous updates on contract terms, fee schedules and reimbursement rules: To ensure claims pricing is accurate, the MDeverywhere team monitors your contracts and continually updates your practice specific knowledge base with any new contract terms, fee schedules and reimbursement rules.
- Identification of underpayments: The MDeverywhere system uses your practice-specific knowledge base to compare payments received against the contract terms and flags underpayments at the line-item level.
- Contract-based appeals: MDeverywhere appeals every underpayment that is identified and provides the carrier with the contract-based explanation needed to successfully process the appeal.
- Follow-up appealed claims: MDeverywhere follows up on every appealed claim and makes sure the payors are paying what they are contractually obligated to pay.
- Reporting and analysis tools: Using the data stored in our system we can create custom reports for monitoring overall payor performance and negotiating improved contract terms.
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