Maria Todd, CEO of Mercury Healthcare International, the parent company of MHI Revenue Cycle explains,"Employer-
A recently published U.S. GAO report states as few as 0.5% of ERISA claims appeals are initiated and that the national success rate for these appeals has been between 39% and 59%.
Healthcare providers have always been able to appeal adverse benefit and coverage decisions, but most hospital and other healthcare provider patient accounts staff were never adequately trained how to properly go about this procedurally intense workflow. As a result, these claims are often set aside and never aggressively worked, or are outsourced to service bureaus.
Since many service bureaus hire former hospital patient account staffers away from hospitals, service bureaus are equally ineffective or are simply not interested in processing these complex claims.
Traditional revenue cycle service bureaus work on volume and handle the garden variety of claims follow up so that their hospital clients are satisfied with results, but these complicated, high-dollar claims are frequently neglected or abandoned by most of the service bureaus in favor of more easily recoverable accounts. Some bureaus specialize in self-pay collections;
Since most service bureaus lack these skills or are not set up to handle these complex accounts, they filter ERISA claims and personal injury accounts out of their workflow and don’t even try to work them. “What’s most frustrating to us as specialized ERISA troubleshooters is that the service bureaus often don’t return these accounts to the hospital for re-placement, so often the accounts go uncollected.”
“There’s no defensible business case for abandoning these revenues, especially when MHI Revenue Cycle will work them on contingency with no up-front cost to the provider.” The number of dollars at stake increases daily as number of employers opt to move away from traditional insurance and self-fund their health benefits in response to threats of Cadillac taxes and runaway renewal costs for fully-insured health benefit plans.
Our team includes seasoned revenue cycle experts including:
Health law attorneys with specialties including, but not limited to insurance bad faith, ERISA, health plan operations and compliance, personal injury, workers comp and probate
Certified Payer-Provider Dispute Mediators
Medical Certified Professional Coders® (CPC®)
Certified Patient Account Managers (CPAM)
Certified Document Imaging Architects (CDIA)
Registered Health Information Administrators (RHIAs)
Certified Healthcare Collections Specialists (CHCS)
Former health plan executives and contracting specialists
Health law specialty paralegals
Former patient accounts managers and Hospital CFOs
Former medical and dental group practice administrators
Former pharmacy executives, and
Physician experts on call for medical necessity and clinical denials and appeals support
Todd is no stranger to managing complex reimbursement appeals and problem-solving troublesome managed care and revenue cycle problem accounts for hospital and physicians. A trained health law paralegal and certified mediator for more than 20 years, she expanded the business adding revenue cycle experts and paralegals. The business continued to grow and was handled through AskMariaTodd™
She is the author of 10 peer-reviewed industry trade books and has trained thousands of hospital and revenue cycle specialists through classes offered by HFMA for more than 19 years. In those classes, she covered ERISA claims troubleshooting and ERISA contracting nuance.
Recent developments in ERISA under PPACA and its significance in the revenue cycle has grown such that a separate class is offered through the Healthcare Business Institute, a new non-profit educational institute just to address ERISA claims management techniques. HBI fills the revenue cycle and managed care training void in the industry as many associations have refocused on healthcare reform topics.
MHI Benefits Group, a sister subsidiary, is one of fewer than five national benefit consulting firms helping ERISA employers test innovations such as domestic medical travel for group health benefit plans. MHIBG offers ERISA plan sponsors access to a proprietary network of more than 6000 inspected and accredited hospitals, 9000 outpatient surgery centers and 850,000 credentialed and privileged physicians in all 50 states in the USA and in 95 countries. The network is designed similar to a globally integrated, standalone PPO but has many advanced infrastructure features. "Our expertise with ERISA is extremely well-developed and unparalleled because of our deeper understanding of ERISA that is necessary to operate and contract for the provider network, function as its specialized TPA, and work closely with ERISA plan sponsors to get claims paid. It’s very synergistic for all concerned,” says Todd.
With recently enacted healthcare reform changes under PPACA, which include sweeping claims regulations that went in effect for all group health plans and individual policies for both ERISA and non-ERISA claims on September 23, 2010, we expect to improve our exceptionally high success rates because of the sweeping Federal Health Reform Law that adopted ERISA claims regulation in its entirety as the minimum PPACA internal appeal standards.
MHI Revenue Cycle accepts an initial pilot program with just 10 inpatient claims and no up-front cost. “Our methods and procedures are managed by experienced attorneys, carried out by paralegals and patient accounts experts, and rarely require litigation or court involvement. Hospitals pay a modest percentage of the recovery when we are successful; otherwise there’s no charge.”
Located in downtown Denver, Colorado, MHI Revenue Cycle (http://mhirevenuecycle.com) is one of very few national recovery service bureaus specializing in ERISA and personal injury claims troubleshooting for healthcare providers in the country. For additional information, hospitals and other providers should contact MHI Revenue Cycle at 800.727.4160 today. Just 10 inpatient claims is all it takes to try us out.