Every year hospitals and other acute care providers forfeit millions of dollars in unrecovered reimbursement, funds that are available and compliant – if one only knows where to look...

mCare finds this missing revenue for its clients.

Since 2005, mCare Solutions has analyzed millions of discharges – and recovered more than $200 million in reimbursements. Our client list includes approximately 350 for-profit and not-for-profit hospital systems as well as individual community hospitals and other healthcare providers from across the country.  

mCare takes a small contingency fee on reimbursement dollars recovered for the hospital and there is zero cost to get started.

Medicare Revenue Recovery Services
 

In a declining reimbursement environment, mCare is a partner to increase the bottom-line

 

mCare is a technology-enabled healthcare services company.

mCare captures hidden reimbursement through the discovery of underpayments in Transfer DRG Review for both Medicare Fee-for-Service and Medicare Advantage, through Indirect Medical Education (IME) “shadow claim” review, and through coverage discovery with self pay to third party revenue conversion including commercial and Medicare Secondary Payer review.


Denial Management and Outpatient Revenue Recovery

  • Feedback complete with proactive corrective measures to ensure denial prevention
  • Denial benchmarking and trending reports with root cause identification
  • With the use of historical payment data, we can predict future payer behavior to initiate corrective measures at the provider and/or payer level
  • Reporting that reveals payer and payment trends, denials by reason and procedure codes
  • Experts available to target key problem areas with training and education
  • Increase payments and reduce unintended write offs
Denial Management Outpatient Revenue Recovery

Transfer DRG Reimbursement

Transfer drg

  • 1-3% - Average provider billing error rate
  • $2,800 -  Average reimbursement per claim
  • Automated processing via Common Working File
  • Streamlined implementation process limits IT burden for providers
  • Technology facilitates high volume processing
  • Turn-key solution with no additional cost for data retrieval, research, billing, follow-up and payment monitoring
  • Detailed client-level reporting to enable process improvement

Payer Search

  • 20% - Average demographic error rate for self-pay/uninsured accounts
  • 3-8% - Missed coverage on self-pay/uninsured accounts receivable
  • Process and technology limitations in patient access functions result in revenue leakage
  • Technology solutions allow mCare to automate the search for existing coverage on self-pay/uninsured accounts
  • Demographic and social security logic allow for increased coverage identification
  • Additional charity and account scoring solutions can streamline performance
Payer Search Payer Verification

IME Shadow Claim Services

IME/Shadow Claim

  • 5% - Average unbilled IME/Shadow claims for Indirect Medical Education
  • $1,000 – Average reimbursement per identified IME claim
  • Identified claims can be billed by the provider or by mCare at no additional cost
  • Technology solutions utilize advanced scripting 120 days post discharge to automate the Medicare Advantage data process
  • Improve compliance for CMS reporting requirements for Medicare Advantage utilization
  • Avoid timely filing denials associated with IME claims submission

CDM Services

  • Emphasizes line-by-line, item-by-item scrutiny, not just an overview
  • Interviews with chargemaster staff, revenue cycle team members, and department managers
  • Develops detailed reports with recommendations that enhance compliance, improve accuracy and encourage issues “ownership”
  • Supports implementation of recommendations
  • Updates charge sheets and order entry systems
  • Validates drug billing multipliers
  • Examines maintenance and charge-capture policies and procedures.
CDM Services
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