What We Do

 

Leveraging more than 30 years experience, our professional staff coupled with our proprietary technology, delivers timely and accurate expected contractual reimbursement for all third party payers. We have not met a contractual term or condition we could not accurately calculate.
Managed Care Professionals, LLC (MCP) is owned and operated by SourceHOV. Since February 1994, our core services focus solely within the revenue and reimbursement cycle specializing in third party payer contractual reimbursement. Our professional staff is comprised of Certified Public Accountants, Registered Nurses, Accountants, Financial Analysts, and Certified Coders.
MCP has partnered with over 1,000 healthcare provider organizations and recovered in excess of $4.0 billion dollars in additional reimbursement. On behalf of our clients we have programmed, reviewed, and negotiated more than 50,000 third party payer contractual agreements.

Key Features

 

Contract Management

 

§  Load and maintain all third party payer contractual agreements

§  Accommodates unlimited contract years for respective payer

§  Contract start and end dates allow retrospective adjustments

§  Scan and attach contractual agreement to respective account

§  Calculate complicated terms and conditions via programmed rules

§  Prompt updates and immediate system enhancement releases

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Retrospective Underpayment Identification & Recovery

§  Review third party contractual reimbursement for the most recent 2-3 year period

§  Recover previously unidentified and unrecognized revenue

§  Contingency fee based on monies identified and collected from third party payers

§  Monitor past and future contract performance

§  This money is rightfully and contractually due your organization!

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Concurrent Underpayment Identification & Recovery

§  Review third party contractual reimbursement

§  Monitor all claims at the time of final billing

§  Identify and pursue all underpayments at time of initial payment

§  Avoid timely follow-up contractual limitations

§  Contingency fee based on monies identified and collected from third party payers

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Contract Modeling

§  Third party payer contract modeling system

§  Accurate expected reimbursement for future and current agreements

§  Multiple scenarios utilizing the most recent one year patient data set

§  Arrive at the total dollar and percentage increase or decrease

§  Powerful and popular tool

§  Option to choose a fixed monthly or per agreement fee

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Calculation Engine

§  Third party payer calculation engine and adjudication system

§  Calculate and post contractual allowance and expected reimbursement

§  Shadow or replace your existing in-house contract management system

§  Correct and supplement your current process

§  Appropriate patient registration and payer plan assignment

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Patient Responsibility Estimator

§  Increase Point of Service patient payments by providing accurate estimates

§  Initiate communication with patients regarding payment options

§  Identify potential charity and financial assistance sooner

§  Reduce follow-up time and associated expenditures

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Data Mining

§  Store pertinent data including 837, 835, and contractual agreements for easy retrieval

§  Unlimited query and reporting capability utilizing stored data

§  Request query or report, experience no delays, immediate response

§  Utilize at your request and convenience

§  Contractual agreements maintained for current and future usage

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Valuation Services

§  Value potential healthcare provider to be acquired

§  Load all contractual third party payer agreements

§  Verify correct third party payer assignment

§  Calculate and compare net revenue of potential acquisition

§  Provide standard and custom valuation reports

§  Identify and recover retrospective underpayments

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Audit Track

§  Designed to assist providers during the Recovery Audit Contractor (RAC) Program

§  Accommodates all audit types including CERT, MAC, MIC, RAC, ZPIC

§  Financial management and appeals analysis tool providing an end-to-end solution

§  More than a tracking tool, experience a comprehensive software and analytic solution

§  Provides real-time, ongoing prompts, reminders, alerts, dashboards and standard and custom reports

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Reimbursement Cycle Solutions Summary

§  Every inpatient and outpatient account

§  All contractually obligated third party and governmental payers

§  Unlimited reporting and query capabilities

§  Reporting on any component contained on the 837 and 835

§  Timely implementation providing immediate results

Information Technology Friendly

§  Data request includes 837, 835, and third party payer agreements

§  SourceHOV loads and maintains all third party payer contractual agreements

§  No hardware or software costs

§  Proprietary SQL based system utilized by our staff

§  SaaS model

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