MCA identifies underpaid and unpaid Medicare Inpatient and Outpatient claims and then follows-up to get them paid correctly for your hospital. MCA is always in full compliance with Federal Regulations governing Medicare Inpatient and Outpatient payments under PPS and OPPS. 

MCA accurately and thoroughly identifies dozens of different kinds of claim payment errors and gets them corrected and repaid by Medicare. CMS and Fiscal Intermediary computer edits were designed to prevent overpayments to providers and are biased toward that objective. Providers are left on their own to find and correct underpayments. For that reason, MCA works to find hospitals all of the underpayments that otherwise fall through the gaps.

How We Perform a Medicare Review Project

MCA combines years of Medicare reimbursement experience gained from working with some of the largest organizations in the Healthcare Industry with MC AnalyTXs' custom developed and wholly owned suite of ORACLE® based software programs to calculate expected reimbursement for every Medicare Inpatient and Outpatient claim. MCA's independently computed expected reimbursement amount is then matched to the Medicare payment actually received by the client. All differences are individually researched and payment error documentation is created.

MCA does not up-code or in any way change the character of any claim. Before any claims are rebilled by MCA, the hospital's staff has an unlimited opportunity to thoroughly review all payment error documentation. Adjusted claims are never submitted until payment errors have been rigorously documented and verified by MCA and the hospital's staff. 

MCA organizes and manages all follow-up activity, including any required letters or meetings necessary to obtain final claim resolution.

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