MEDICAL PRESENT VALUE'S PHYNANCE™ SERVICE INCREASES MEDICAL GROUP'S NET COLLECTED REVENUE BY 3 TO 6% ONLINE CLAIM AND VERIFICATION SERVICE ALSO SHORTENS BILLING CYCLE AND IMPROVES MEDICAL OFFICE WORKFLOW EFFICIENCIES
MEDICAL PRESENT VALUE'S PHYNANCE™ SERVICE INCREASES MEDICAL GROUP'S NET COLLECTED REVENUE BY 3 TO 6% ONLINE CLAIM AND VERIFICATION SERVICE ALSO SHORTENS BILLING CYCLE AND IMPROVES MEDICAL OFFICE WORKFLOW EFFICIENCIES
(PRWEB) June 6, 2002
SAN ANTONIO, -- Medical Present Value (http://www. mpv. com (http://www. mpv. com)), a health care company striving to align and bring uniformity to financial transactions between payors and providers, says medical practices deploying its Phynance(TM) service have realized increases in net collected revenues of 3-6%, based on successful identification and appeal of underpayments.
"For the typical $50 million physician partnership, our Phynance service can help the practice recover anywhere from $1.5 million to $3 million," says James M. O. Rubin, MD, president and chief executive officer of Medical Present
Value (MPV). "Equally important, payment contracts are now fully understood, and their performance is accurately measured."
MPV's Phynance service is an innovative Internet-based claim and payment verification service that automatically verifies the accuracy of all claims and payments by payor, contract and line item. The resulting "contract transparency" improves business processes in the medical group and throughout health care. By helping lower health care administrative costs, the Phynance service ultimately benefits patients and their employers.
MPV's Phynance service has been shown to bring significant value to physician practice groups especially those with over 20 physicians. MPV is currently focusing on mid-size and larger specialty groups, large multi-specialty groups, and faculty practice plans at academic medical centers.
A study conducted by MPV for the Texas Medical Association (TMA) has helped quantify the extent of the underpayment problem for medical groups:
-- One of five claims by MPV's Texas provider clients was valued by payors below the contracted amount.
-- The value of these claims averages five percent of a practice's net-collected revenue.
-- Many of these problems involve claims with multiple line-items billed per claim, especially those that involve surgical and other specialty procedures.
"Since the onset of managed care, there has been a steady deterioration in the ability of physicians, hospitals, payors and patients to understand reimbursement and the contracts and payment policies that drive it," explains
Dr. Rubin. "These vaguely defined contracts and policies create staggering problems."
For one, the lack of contract transparency frustrates medical groups' efforts to budget, plan and finance operations because practices do not know in advance what they will be allowed for submitted claims, according to Dr. Rubin. Moreover, appeals are scattershot and ineffective. When practices challenge the allowed amount, they are generally unable to justify, with precision, the appropriate contractual value.
Exacerbating this problem are two factors:
-- Reimbursement is based upon contracts, and the contract terms and payment policies are usually not fully disclosed to providers
-- Payors use multiple line item adjudication, with the value of each Current Procedure Terminology (CPT(R)) code on a claim depending on
The presence of other codes and modifiers, bundling edits, "medical necessity" criteria and complex rules
Adding to the complexity, most current physician reimbursement systems draw on the Medicare physician fee schedule and resource-based relative value scale (RBRVS), which have altered the health care reimbursement landscape in the past decade.
"Payors also suffer from a mirror image of the problems facing physicians and hospitals," emphasizes Dr. Rubin. "The confusion has forced payors to create a time-consuming and costly infrastructure to address both substantiated and unsubstantiated appeals."
MPV's Phynance service is the first solution to truly empower medical groups, as well as payors, to deal effectively and accurately with their contracts. Integrating along side medical group's practice management system (PMS), MPV's Phynance service relies upon claim data that are already flowing through the PMS. On a daily basis, the tool evaluates claim data at two points in their life cycle:
-- First, Phynance software values claims. Contract level errors are identified before filing, allowing for review & correction prior to
Submission, thus reducing payment cycles by submitting cleaner claims. In addition, these pre-payment values for all claims allow
Groups to maintain more accurate accounts receivable.
-- After payment allowables are posted to the PMS, Phynance software flags contract-level errors in allowed amounts and their code-level sources, providing concise and accurate explanations for informed and successful appeals or refunds to payors.
"Phynance reporting modules also provide powerful tools that enable medical practices to produce custom reports on a broad range of practice metrics," continues Dr. Rubin. "Physicians and their staff can use information about payor performance to eliminate poor performing contracts and/or negotiate improved contracts."
About MPV Phynance
MPV's Phynance solution is a set of products and services that fully defines all of a client's government and commercial fee-for-service contracts. Working alongside the client's practice management system, Phynance software automatically calculates the contractually obligated amount due for each claim and verifies the accuracy of allowables by contract, by claim, and by line item. MPV's Phynance service combines rules-based claims valuation technology with a powerful run-time database to deliver superior reporting capabilities and a robust application service provider (ASP) environment providing continual software and data updates. MPV's Phynance service is compliant with
The Medicare Internet Policy. Its security and privacy practices will be fully compliant with the final HIPAA security and privacy regulations as issued and implemented.
About MPV
Medical Present Value (MPV), based in San Antonio, Texas, is an information technology services firm aligning financial transactions between health care payors and providers. The company's powerful contract-based solutions bring clarity and accuracy to the complex claims, contracts and reimbursements flowing between physicians, hospitals, and payors. The company currently has over 30 clients, representing over 1,200 Texas physicians, hospital and payor clients including Medicare, and is expanding nationally in 2002. MPV is endorsed by the Texas Medical Association (TMA), the Texas Orthopaedic Association (TOA), and the Illinois State Medical Society (ISMS). For more information about MPV and its products and services, visit the company's Web site at http://www. mpv. com (http://www. mpv. com).
# # #
=====================
Jerry Schranz
CPRi Communications, Inc.
370 North Street
Teterboro, NJ 07608
201-641-1911 Phone ext. 14
Jschranz@cpronline. com
