Reimbursement and Fee Analysis
Physician Advocates of Minnesota does a complete review of Top 300 codes that you bill for, keeping special attention to those that you either bill frequently or bill at a higher than average fee. This is the first step before An example [all data used is for explanatory purposes only] is shown below, using the Top 300 codes: [Exhibit 1 - "Click on" picture to see detail...]
Physician Advocates of Minnesota then checks the codes against the contractual payments that you received from Medicare, as well as other payers. The objective is to make sure that you are billing appropriately so that you receive the allowables from all of your contracts. This step in the process would normally take hours, if not days, for you to gather all of this information from the multiple fee schedules that you have under contract. But since we have these fees already loaded in our model, this allows us to quickly determine the price points for your medical group. The result gives us instant information on how your medical group would be effected by the repricing [Exhibit 2]:
Physician Advocates of Minnesota will then take this information and put together a health plan portfolio that will rate your contract rates from low to high. This is done on an aggregate basis, but it helps you focus your and ours efforts. And those efforts are directed at getting your lowest payer to negotiate more fairly with you and give you more market competitive rates. We take into account everything from your 'Gross/Aggregate" Conversion Factor and add/subtract all of those items that adjust your payments [withholds, administrative fees, late payments, etc.] to give you the best apples-to-apples comparison [Exhibit 3]:
We take into account that some of payer are paying you slower than others, some promised the return of a withhold that didn't materialize, some use MN GPSI's and others don't, and still others are using the Medicare RVU's from over two years ago. This model will give you the net answer to your questions of who is paying you the best and who is paying you the worst.
To summarize, we give you the best snapshot of your medical group's 'State-of-the State' to know your financial health with the plans. We believe we give you all of the following advantages:
- We provide a summary each contract cycle with detailed reports to keep you and staff updated.
- There is no disruption to the daily operations of your staff.
- We know the key people in the Minnesota Health Plans to address your payment issues.
- You receive information showing you which of the health plans are not meeting Minnesota's Prompt Payment Provision that took effect 1-1-2001.
- Information on contract terms and definitions that are being used by the health plans to their advantage.
- Financial penalties charged inappropriately to your organization and unjust discounts taken.
- The 'creep' or increase in patient responsibility [copays/deductibles] that the health plan is making you take in your contract with them.