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Provider Services
How do you assure prompt and appropriate revenue in an environment of complex requirements?
Due to the complexity of voluminous, conflicting, complex regulatory requirements and relationships within public and private payer
contracts, ever-increasing medical costs, and shrinking reimbursement dollars, the management of healthcare transactions and claims is an
enormous challenge – a specialized understanding of the marketplace is critical to obtaining prompt and appropriate payment
Improve Financial Performance through Data-Driven Audit and Control
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Challenges in Healthcare Today
Declining Reimbursement Rates
Fragmented Contractual Arrangements
Increasing Uncompensated Care
Increasing Regulatory Arrangements
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Medical Business Associates Solutions
Manage Reimbursement Effectively
Make Cost Efficient Data-Driven Decisions
Ensure Payer Contract Compliance
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Medical Business Associates, Inc.’s audit experience throughout the entire healthcare continuum enables us to provide expert structure
and support to ensure the financial and information integrity necessary to help you capture full and accurate charges.
Medical Business Associates Provider Audit Services
Revenue Cycle Assessment and Management
Audit, review, and identify vulnerabilities in payer contracts
- Assess clinical and financial denial management process
- Identify payer and provider contractual and claims processing issues to address the denial activity
- Determine the cause of denial activity and implement payer-friendly claim format
- Provide proprietary Exploratory Data Analysis of payer claim activity to generate data intelligence
- Case management tools - PortFoliasm
Payer Defense Audits and Denial Management Support
Ensure valuable provider representation, deter inappropriate denials and RAC responses, and minimize collection expenses
- Support payer and workers’ compensation audits (defend inappropriate write off of a diagnosis by the workers’ compensation carrier)
- Prepare provider bills for a complete review by payer
- Provide side-by-side review and defense of provider bills with the payer representative
- Accelerate collection process by obtaining a written agreement with the payer representative
Forensic and Dispute Support
Expert and administrative support services
- Expert testimony on reimbursement and internal controls
- Exploratory Data Analysis of health, reimbursement, and operations information
- Research, case organization, and data preparation and data management
Training Support for Business Office and Nursing Staff
Optimize claims denial revenue capture
- Reimbursement and claims processing/coding training for provider financial services administrators and claims handlers
- Teach nurses how to document charges appropriately and pro-actively monitor patient services provided and charges entered
Improve documentation and address market trends
- Document compliance and information integrity training
- Teach how to develop data-driven models for hospital operations
Patient Advocacy Support
Provide patient support for benefit denials including access to PortFoliasm
Concurrent Audits
Post discharge review of inpatient and outpatient bills to identify and capture missing charges and submit discrepancies prior to final billing
- Capture lost hospital revenue
- Evaluate documentation and compliance
- Improve billing accuracy
Charge Master Review
Identify missing revenue, apply appropriate pricing, and ensure integrity for each cost center
- Recognize pricing variances compared to market norms
- Review codes assigned to hospital charges
- Verify that all current services are listed in the correct department
- Address missing charges
Financial Case Management
Assure accurate revenue in an environment of complex reimbursement requirements
- Manages the constant change in payer requirements on a concurrent and proactive basis
- Ensures appropriate documentation of patient services imperative to correct reimbursement and avoiding claim denial
- Prevents errors at the time of patient service and before discharge
- Errors may occur in areas such as patient access, physician and nursing documentation, clinical data and medical record management,
resource management, and patient accounts
For more information on our Provider Advocacy Services, please fill out a request form.
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