Physician groups utilize MPV Contract Management to verify reimbursement claims

Sep 10 2009

Medical Present Value, Inc. (MPV) today announced new contracts with four physician groups representing more than 2,600 providers to help monitor payer compliance and automate processes related to payer adjudication management and oversight.

The groups, which will utilize MPV Contract Management, include:

• University of Utah Medical Group, a 1,100-physician organization based in Salt Lake City;
• Continuum Health Partners, a New York-based group with 700 physicians;
• Texas Children’s Physician Services Organization, a 623-physician organization located in Houston; and
• Moses Cone Health System, a 250-physician group located in Greensboro, N.C.

“In addition to verifying that our reimbursement matches the terms outlined in our payer agreements, we also wanted an automated, more efficient system for tracking the status of our appeals,” said Dayle Benson, executive director at University of Utah Medical Group. “MPV not only enables us to accomplish these objectives, but it also integrates seamlessly with our existing practice management system, which will allow us to quickly reap the benefits of the system.”

MPV will model the groups’ payer contracts line-by-line into the MPV Contract Management application—creating a database of client-specific contract terms, fee schedules and payment policies. This enables the groups to verify reimbursement accuracy and better identify, aggregate and appeal claims paid at less than the contract rate. In addition, groups can utilize this data to generate estimates of a patient’s out-of-pocket expenses at or before the time of service, resulting in increased time-of-service collections, reduced bad debt and improved patient satisfaction.

“With the increasing financial pressure that practices face and the continued growth of consumer-directed care, it’s more critical than ever to capture accurate payment from both payers and patients,” said John Nickens, vice president at Texas Children’s Physician Services Organization. “MPV Contract Management will allow our group to secure accurate payment by identifying and recovering contractual underpayments from payers and giving us the tools we need to provide patients with detailed estimates of their financial responsibility.”

By using the data stored in MPV Contract Management, healthcare organizations can also analyze the impact of new and proposed contract terms and tailor their negotiating strategy to those items that will have the most significant impact on overall reimbursement.

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