When claims are improperly denied or underpaid by third-party payers, medical consumers are left with the financial burden while the providers are left with the risk that their patients can't or won't pay their balance.
This problem can be financially crippling for solo and small practices. For that reason, MedClaim Alliance (MCA) offers a novel and profitable solution for these providers.
We provide medical claims advocacy services to patient customers who are facing reimbursement challenges. As a patient advocate, we utilize the patient's benefit plan coverage and federal ERISA law to capture full payment liability from third-party payers. This process is distinct from the typical provider disputes and appeals process. Whereas, benefit denial appeals are oftentimes more successful than provider claim appeals. This is especially true for non-par provider appeals.
It may surprise most medical providers and billers to learn that when patients have an employer-sponsored health benefits plan (which is the majority of the time), it is not always the same as the policy coverage information provided by their insurance. And with that, many times the patient's benefit plan covers more than what the payers typically pay.
For that reason, we utilize federal ERISA law that governs most employer-sponsored plans which make up over 80% of commercial insurance claims. This powerful law along with our benefit denial appeals process allows us to capture additional payments on many claims where provider appeals have had little to no success.
Sometimes patient customers just need their insurance to pay their full responsibility before they can pay their share of the cost. When providers offer our service to their patients, it increases payments from both third-party payers and patients while enhancing patient satisfaction. This in turn creates greater customer retention and referrals. It's a win-win for everyone.
On average, our medical claims advocacy service increases provider revenue by 10-40%. Although, it can be even higher in some cases.
Below are some examples of claim denials and underpayments where we can recover additional third-party payments on many claims even after provider appeals have failed:
It's common in today's healthcare industry for insurers to put profits over the health and well-being of their members. Claims are improperly denied or underpaid to make a profit and most consumers have no idea that they are being taken advantage of by the very company that pledges to keep them "healthy".
Although providers' billing staff do their best at following up on denied and underpaid claims, they understandably fall short many times at combatting payers' aggressive and improper tactics. This is largely in part because most providers and billers are unaware that over 80% of commercial insurance claims are for employer-sponsored plans that fall under federal ERISA regulations and guidelines for filing appeals. Wherefore, payers can deny (ignore) provider appeals that don't follow ERISA guidelines.
When over two-thirds of all commercial claims are governed by ERISA law, it's imperative that ERISA appeals are utilized in the revenue cycle process. However, the ERISA appeals process is timed and must be followed to the letter. For that reason, most medical providers, billers, and revenue cycle companies do the appeals process incorrectly, leaving valuable revenue on the table.
ERISA can help recover 100% of contracted payments minus patient responsibility for in-network claims and 100% of billed charges minus patient responsibility for out-of-network claims.
MedClaim Alliance is an outside patient advocate service making full use of the ERISA Claims Regulations and appeals process, which in turn increases reimbursements while also enhancing patient satisfaction. And all appeals are conducted as a patient advocate and never on behalf of the provider, thus eliminating any concern for retaliation from payers.
As a healthcare provider, it's time to add medical claims advocacy to your revenue cycle process. Your patient customers will thank you handsomely while you collect more revenue.
No contract or BAA needed.
Since we operate as a patient advocate, we actually work on behalf of medical consumers, not the providers.
Our provider partners simply provide their patients with our two document forms to fill out one time only, usually at intake. Our forms allow the patient customer to (voluntarily) designate MedClaim Alliance as their patient advocate and authorized representative for appealing any denied or underpaid claims.
Our documents also inform the patients that their provider is providing this professional service free of charge to the patient. This shows the patient customer that their provider has gone above the normal standard for providing medical services with the aim to give the best possible healthcare experience to their patients. The documents also provide authorization for the release of health information pursuant HIPAA.
Because we are performing services on behalf of the patient, not on behalf of the provider (covered entity), we are not considered a business associate under HIPAA regulations. Thus, a business associate agreement (BAA) is not needed. This means that our partnered providers never need to be concerned about any third-party data breaches or HIPAA violations when using our services.
Also, a contract is not necessary. So long as any partnered provider pays our small fee on behalf of their patient customers, we will continue providing our service to their patients and no contract is needed. It's that simple.
Why MCA is better than other service providers.
If you're seeking to increase your reimbursements, you'll find that most denial management companies only focus on contractual and/or billing error denials and underpayments. Very few will challenge, little alone successfully overturn, improperly denied, and underpaid claims.
What's more, most billing companies, revenue cycle management companies, and even denial management and revenue recovery service providers fail to effectively use relevant federal ERISA law to compel third-party payers into paying their full payment liabilities. Some are completely unaware of ERISA while others who are aware of this federal law either cannot or will not utilize it effectively because of how complex and time-consuming it is.
Whereas, here at MCA we confidently utilize the ERISA Claims Regulations appeals process even when provider appeals have already been exhausted without success.
Even though we specialize in ERISA claim appeals, we can appeal any non-ERISA claim as well. When dealing with non-ERISA claims, we utilize all available state and federal regulations. We also involve government agencies when necessary.
We partner with all types of solo and small healthcare providers. And because it is our mission to help these providers who we believe are in need of this type of service the most, we have addressed the following concerns that sometimes cause these providers to be disinclined to seek help.
1. No software is needed.
2. We work in harmony with billing procedures already in place and there's no interruption to any collection system.
3. It doesn't matter if your billing is in-house or outsourced, our process is the same.
4. This is an extremely simple process with no learning curve or big changes.
5. There's no financial risk for trying our services because we work 100% on a contingency fee basis. We only get paid after our partnered providers do.
6. Other ERISA claim recovery providers charge 30% or more of captured revenue. Our fees are more affordable for assisting solo and small practices.
7. Our disputes with the payers are on behalf of the patients and not the providers, so there's no concern for payer retaliation.
8. Since we work on behalf of the patients and not the providers, we're not considered a business associate under HIPAA regulations, and no BAA is needed. So there's no risk or concern for third-party data breaches or HIPAA violations.
9. There's no binding contract.
10. We can even collect on old accounts going back several years.
Our benefit denial appeals process is an absolute must for collecting proper and full reimbursements, especially for out-of-network claims.
We uphold the highest level of integrity in all aspects of our business. We are faith-based and treat every person with respect, dignity, and honesty.
Our medical claims advocacy service provided to your patient customers will enhance patient satisfaction while increasing your revenue.
Why wait when you could be easily collecting more revenue for your practice while giving your patients a better healthcare experience? Contact us today and start collecting your rightfully earned full reimbursements. Both you and your patients will be glad you did.
