How are your reimbursment rates calculated?
Our database compiles annualized reimbursement data from over 2.4 million healthcare claims nationally. Based on the average accepted reimbursement rates for health insurance, reported specific cost data and historical charge reports we can recommend discounts and negotiate with providers on behalf of our clients to reduce costs and increase our clients’ bottom line. Our reimbursment model is based on what the provider actually receives in reimbursement rather than what the provider charges.
What is the turn around time on claims reviews?
We guarantee a turnaround time of 48 hours or less for every claim review.
How are MedCost Contain's cost containment strategies compared to other methods?
Consistent savings are realized across the country
Discounts are not based on a percentage of subjective provider billed charges
Audits of coding edits, unbundling of charges and modifier-specific adjustments
How does MedCost Contain handle claim reviews?
MCC conducts focused reviews on every claim based on objective standards of Fair & Reasonable reimbursements and the nationally accepted standards of medical billing coding. This provides higher savings over other methods of claim reviews. Our highly trained audit teams provide recommended payment amounts via the Explanation of Review (EOR) documents. We handle all provider push back and disputes in order to minimize any effort by our clients, allowing them to focus on other areas of their business.
What can my company do to make servicing our claims easier?
Simply provide us with a copy of the UB-04 or CMS 1500. With that, we run claims through our re-pricing engine and provide you with a detailed report to attach to your provider remittance. We also give you customized savings reports and appeal reports regularly.
What are some of the benchmarks used to establish payment guidelines?
We use many different benchmarks, including rates specific providers accepted previously, geographically-specific Medicare rates, state Worker’s Compensation rates, cost-to-charge ratios, negotiated provider reimbursement rates, hospital-reported financial data, National Correct Coding Initiatives Edits (NCCI), and more to establish Fair Market Pricing data.
How is MedCost Contains pricing different?
Our database compiles annualized reimbursement data from over 20 billion healthcare claims nationally. Based on the average accepted reimbursement rates for health insurance, reported specific cost data and historical charge reports we can recommend discounts and negotiate with providers on behalf of our clients to reduce costs and increase our clients’ bottom line. Our reimbursement model is based on what the provider actually receives in reimbursement rather than what the provider charges.
What happens if a provider issues an appeal on a claim?
We handle all communications and negotiations with providers regarding claims appeals to minimize provider confusion and discontent.
What happens when a provider contacts MCC about a payment recommendation?
We take full responsibility for defending our payment recommendations any time providers contact us. We provide detailed explanations illustrating how the determination was created, and address each area of concern. We follow up with the provider to verify $0 balance on accounts and maintain Appeals Logs. If providers request additional payments, we contact clients regarding amounts allowed for negotiated settlements. If providers are unwilling to settle and proceed with balance billing the patient, we continue to defend our recommended payment and attempt to absolve the patient of responsibility for amounts over the allowed payment.
