Emergency Medicine Physician Billing Solutions:

Our expertise in coding is a big part of why we can guarantee we will raise net revenues for clients.

Unparalleled coding is only the beginning. Equally important is our broad, deep experience with the reimbursement levels that are legitimately achievable for a host of payors—from Medicare and Medicaid to Tri-care to multiple private insurers, as those levels continually change. And no other company pushes that experience like we do on your behalf. We’re known for our tenacity and efficiency.

On the level of the individual claim, we will never be satisfied to show you a 5% increase on appeal if we know a 200% increase is possible. And if 200% is indeed possible and legitimate, we’ll pursue it all the way through litigation, and more.

On the industry level, we continue to take on big issues that affect reimbursement—like assignment of benefits—with personal involvement in legislation, education and litigation. We are constantly advocating on your behalf.

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Information Technology

We use our proprietary billing software (MG2).  The MG2 system is supported by a team of programmers with extensive experience in healthcare applications. Housed in a 40,000 square foot facility with a centralized infrastructure, we have dedicated staff on site to continually monitor network operations and production.   Our Billing Management system is continually being upgraded and improved by our in-house programming staff.  These upgrades may be predicated by carrier bulletins, changes in the industry, CPT code changes or other payer or industry requirements – including ICD-10.  Our billing management system has the required advanced features including:

  • HL7, flat file and ASCII capability for interfacing to any software billing or scheduling system
  • Paperless Image Capture which insures accuracy and efficiency
  • Electronic Claims Processing and Remittance Capacities
  • Utilization Tracking and Reporting
  • Billing Compliance Features
  • Line Item Posting of Payments & Adjustments
  • Automated posting (MCR, MCD, BS, MANCR, COMM) remittances
  • Payment posting program captures expected contracted payer allowances and flag accounts as a variance.
  • Advanced Management Reporting
  • Reporting Download Capabilities
  • Physician/Groups logins to view the patient’s records
  • Create flat file of updated patient insurance and addresses for HIM systems

Recognized for its power and efficiency, MGA licenses the MG2 solution to national and regional emergency department Physician Groups to enhance their physician billing practices.

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Claims Processing

We utilize one of the largest electronic claims clearing-house for medical transactions in the healthcare industry, furthermore, has direct connects with several Government payers to turn around reimbursement as quickly as possible. We process more than 3 million medical transactions annually which include claims statues and insurance eligibility. Claims data may be transmitted 24 hours a day, 365 days a year to our national gateway system and are scrubbed in the front-end for errors before submission.  Detailed confirmation reports are provided daily from the gateway and then sent back to the system.  These confirmation reports are then parsed to provide individual claim response recognition. Claims data and all gateway transactions are backed up and electronically and stored offline for up to seven years for audit, back-up and disaster recovery.  It’s a valuable safeguard for your facility or practice.

In addition to transaction processing, we make available www.thedoctorbill.com, a secure internet-based access giving patients the power to easily manage their account and do things like view statements history, make payments, check claim filing history, update or correct personal address and insurance information, request an insurance filing or refilling, and perform a number of other functions that can reduce the burden on staff and streamline the entire payment process.  Besides facilitating account management, www.thedoctorbill.com also gives patients a better understanding of the billing process and the kind of information required to get claims accepted and paid — enabling them to be better prepared for their next appointment with all the necessary information in hand.

Your practice will also be able to access usage reports that tell you how often the site is accessed and why. And because www.thedoctorbill.com is a tool for billing only, you can be assured that no one will have access to your patients’ medical history, treatment or any other medical information not directly pertinent to billing.

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Coding

MGA provides comprehensive CPT and ICD-9 coding from the ED Medical Records to ensure revenue maximization and minimize future payer audits.

Our coding expertise is extensive and covers all emergency medicine services.  All MGA coders receive ongoing specialized training for emergency medicine coding and utilize state-of-the-art medical coding software which ensures consistency and thoroughness. Every coder must successfully complete a stringent training program and then they must maintain accuracy in the face of ongoing quality assurance testing.  The program includes general instruction in medical terminology, human anatomy, ICD-9 and CPT coding and specific training on emergency medicine coding concepts. In addition, compliance topics are introduced throughout the program, and particular emphasis is placed on assigning codes and modifiers only when supported by clinical documentation. All coders must pass rigid quality thresholds before they can code any client’s work.  All work is constantly monitored for quality assurance and measured for accuracy.

In addition, all coding supervisors and quality assurance auditors are Certified Procedural Coders.  All CPC coders must receive 18 CEUs to maintain their national certification.  The MGA Compliance Officer continuously monitors industry news sources and relays all pertinent information to the coding department whether in policies and procedures or memorandum.

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Compliance

MGA believes that the development, implementation and maintenance of an internal compliance program that follows federal guidelines for third-party medical billing companies is integral to achieving an unparalleled level of quality service.  The MGA Billing Compliance Program was created to include all the essential components of compliance, including written policies and procedures, a chief compliance officer, training and education, effective lines of communication, disciplinary guidelines, auditing and monitoring, and investigation and remediation.  MGA’s standards of conduct provide guidance in issues related to business ethics. MGA’s billing compliance policies provide specific direction in dealing with complex regulatory issues related to medical billing.  Together, the standards and policies serve as a map that enables MGA employees to carry out their duties in an accurate and compliant manner.

Client Communication regarding regulatory issues is also extremely important.  MGA will inform clients of the most recent changes in compliance requirements by applicable health care agencies and regulatory bodies. Additionally, all Client Management staff and Coding Staff are updated continually, and MGA holds monthly/quarterly client meetings that cover not only the A/R performance to date, but include the communication of any changes in regulatory issues that may impact their business.

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AR and Denial Management

The importance of managing denials is paramount in addressing issues related to cash flow, compliance, and other regulatory requirements.  MGA has implemented workflow processes and report enhancements that decrease the cycle time and increase revenue by reducing denials. Our Claims Edit Check program allows us to correct certain denials prospectively.

MGA also provides extensive education and training for physicians, schedulers and front-end employees to reduce the amount of denials before a claim is submitted.  Denials are tracked by an internal coding auditor that trends and communicates to appropriate staff / client / managers as needed.  MGA works denials and correspondence daily. Our billing and account management system generates internal reports that target and identify accounts that may require special attention.  Other reports track denials by type of denial, count, dollar amount and procedures.

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Management Reporting

The provision of detailed reports, and the explanation of those reports, is an integral part of MGA’s service.  It is important to MGA that you understand our performance in the provision of services to your organization, and that you have enough information to make tactical and strategic decisions about your business.  During the implementation, MGA standard reports will be reviewed in concert with your practice and decisions will be made regarding your required monthly reporting needs.  MGA will develop additional ad-hoc reports as needed by your group.  Given MGA extensive EM client base, we probably have developed reports to address any situation that you may require.  Samples of standard reports are provided upon request.

Performance Standards

MGA believes that all Emergency Department Physician Groups should continually track the Key Practice Indicators for their group practice to keep ahead of any potential negative financial trends. Key indicators are very dependent on the individual group’s geographic area and payer mix.  MGA develops for each individual client a performance target based on the individual client’s geographic market and payer mix. Key Practice Indicators that MGA tracks and documents for our internal use as well as for our clients are as follows:

  • Average Gross Collection Percentage
  • Average Bad Debt
  • Average Discounts and allowances as a percentage of gross billings
  • Average Usual and customary refund rate
  • Average days in Accounts Receivable
  • Average Net Collection Percentage

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Customer Service Call Center

MGA prides itself on providing the highest level customer service responsiveness in the industry. Our dedicated on-site, bilingual call-center representatives are trained to respond to patient inquiries and collect outstanding payments.  The MGA customer service standard requires inbound calls to be answered with the first 3 rings.  Callers holding longer than 3 rings are routed directly to the phones of a Senior Management member (CEO, COO, and/or President).  In keeping with customer requests and technological advancements, an IVR is also part of the MGA customer service solution, offering patients an easy way to check their balance and pay-by-phone without having to speak with a representative.  The IVR is only activated on off-hours, weekend, and holidays.

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Managed Care

MGA has expertise with local, regional and national payers in your area. MGA also provides services to other physicians in your area as well as all the surrounding states, furthering our expertise and capabilities. Knowledge of what differentiates your practice from other practices in the area is a powerful tool when negotiating managed payment contracts.  MGA can provide assistance or advise in the following crucial Managed Care related services:

  • Matrixing of the agreements
  • Payment/Adjustment profiling
  • Contract gathering, organization and tracking of renewal dates
  • Contract negotiations
  • Contact performance audits
  • Contract adherence for timely filing and payments

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Dedicated Account Management

A dedicated Client Manager is assigned at start-up to oversee a smooth implementation and coordinate Chart Flow Processes, IT Interface, and Education.

Subsequent to start-up implementation, the same Client Manager is responsible for coordinating communication related to billing services for your practice.  Regular, face-to-face, meetings are scheduled to monitor documentation flow and review your practice management and financial reports.

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