Negotiating with payers is a daunting task, especially for independent physicians. Tonyi Long, client development representative at Plano, Texas-based Medical Practice Solutions, noted key reasons payers deny claims, including incorrect coding.
Medicare had a 40 percent improper payment rate for durable medical equipment, prosthetics, orthotics and supplies in 2015, resulting in $3.2 billion losses, according to a Council for Medicare Integrity study.
Although many surgery centers have in-house billing, they usually lack the manpower to bill everything correctly, said Mr. Long.
That's where MPS comes in. The medical billing and processing company doesn't deny any claims, and 97 percent of the claims it receives result in payment. The company has a strong relationship with Blue Cross and Blue Shield and UnitedHealthcare.
In 2013, the American Medical Association found Medicare topped the list for denying claims 4.92 percent of time; Aetna denied claims 1.5 percent of the time; UnitedHealthcare denied claims 1.18 percent of the time; and Cigna denied claims 0.54 percent of the time.
The company mostly works with out-of-network clients across the country, offering billing and coding, credentialing, scheduling, verification, pre-certification and negotiation services. MPS also consults, offering free audits on clients' billing processes.
"One of the things that sets us apart form other companies, is that we won't take no for an answer," said Mr. Long. "If it takes us 20 negotiations with the carriers, we don't have a problem doing that."
MPS' coders underwent extensive training before the transition from ICD-9 to ICD-10, which increased the number of codes from 13,000 codes to nearly 68,000 codes. MPS' coders are fully equipped to help practices maximize reimbursement. According to a Navicure survey of healthcare professionals, 44 percent of respondents experienced nominal increases for denial rates between 11 percent and 40 percent.
Founded in 2011, MPS has locations in the Houston Woodlands and San Antonio in addition to its Plano location. The company anticipates expansion into Colorado.