Automated payer contract management will boost revenue for medical groups

Two multi-specialty medical groups will automate their payer contract management processes and monitor payer compliance to recover and boost overall revenue.

Harvard Vanguard Medical Associates, of Newton, Mass., and WellSpan Medical Group, of York, Pa., will use Medical Present Value Inc.'s Phynance, a Web-based application designed to evaluate overall contract performance to verify reimbursement and assess the financial implications of new and proposed contracts.

Harvard Vanguard is a non-profit, multi-specialty medical group practice that provides care to more than 350,000 adult and pediatric patients at more than 20 offices across eastern Massachusetts. It is an affiliate of Atrius Health, an alliance of non-profit physician groups in Massachusetts. WellSpan Medical Group, a multi-specialty physician group practice and partner organization of WellSpan Health, includes more than 20 sites and 125 physicians.

Phynance is designed to help the medical groups to simplify payer contracts by defining more than 50 variables. It maintains a database of client-specific contract terms, fee schedules and payment policies and continually updates Medicare, state and other payment rules.

Phynance compares payments received against contract terms, verifying allowables and flagging potential underpayments at the line-item level.

The medical groups hope to be able to identify contract-level errors before claims are filed and estimate a patient's financial responsibility prior to the time of service, improving cash flow and reducing patient bad debt.

"As our group continues to grow and expand, we need a robust tool that allows us to identify underpayments, recover revenue and monitor overall contract performance without adding additional staff," said Jack Jensen, chief operating officer of WellSpan Medical Group. "MPV will allow us to achieve all of these objectives quickly and efficiently."

For every underpayment that is identified, Phynance provides a contract-based explanation that gives payers the information needed to process the appeal.

Users can also create custom reports for monitoring overall payer performance, negotiating improved contract terms, tracking chargemaster accuracy and boosting overall practice revenue.

"We are looking for the MPV tools to help us confirm that payments from the payers are routinely and consistently in line with the terms and rules of our contracts at a very detailed level," said Elaine Goddard, director of revenue operations at Harvard Vanguard Medical Associates. "We anticipate that Phynance will allow us to operate more effectively in today's complex reimbursement environment."