Expert Witness Testimony
MCA has a team of professionals who have been qualified as expert witnesses in both state and federal court on a variety of topics. The difference between acquittal or conviction or a fully favorable decision as opposed to an unfavorable decision might rely on the testimony of experienced professionals who thoroughly understand the relevant issues and have the ability to testify persuasively and effectively.
Medical Record Review
State and federal payers such as Medicare, Medicaid and TriCare and third party private payers often conduct medical record reviews to determine the medical necessity of services provided and accuracy of the related billing. MCA professionals are well trained in medical record documentation and audit principles. Many health care practitioners rely on MCA for pre-payment medical record review to identify weaknesses or audit vulnerability. Medical record reviews are also used, as a baseline to identify education needs in billing and coding and documentation guidelines.
Compliance Plan Development and Assistance
The Inspector General's Office of the Department of Health and Human Services (HHS) has made clear that effective compliance programs are a significant part of the future of healthcare regulation and enforcement. MCA offers a team of experienced professionals to assist in initial review of billing and coding procedures, development of policy and procedure manuals, design of training programs and implementation of the finished compliance program.
Insurance Dispute Resolution
Professionals who are thoroughly familiar with AMA CPT-4 procedure coding and ICD 9 CM diagnosis principles often resolve insurance disputes. MCA professionals are often called upon to evaluate disputes and mediate on behalf on the practitioner when appropriate. MCA takes pride in its ability to objectively evaluate every disagreement and to render impartial recommendations. Successful resolution and mediation also lends itself to education, if done effectively and professionally.
Case Development & Discovery Support
MCAs extensive experience and knowledge of the health care industry, particularly billing and coding, has been invaluable to hundreds of legal professionals in the defense of criminal and administrative actions taken by federal, state and private payers. MCA takes pride in its reputation as one of the countrys foremost authorities in health care compliance issues and its ability to assist legal professionals in these often complex cases.
Medicare/Medicaid Audit Defense
The Medicare and Medicaid programs are required by law to conduct post payment reviews on a significant number of health care providers each year. In most instances these reviews lead to substantial overpayment assessments against the audited entity which quite often lead to protracted appeals through a complex system. MCA has defended over 750 medical practices in the past twelve years including physicians of every specialty. MCAs track record in the defense of these cases has been an unparalleled success.
The starting point of every Corporate Compliance Plan should be an initial assessment or Baseline audit. MCAs professionals are experienced in reviewing processes and procedures, billing and coding protocols, information systems, medical record documentation and adherence to state and federal regulations and guidelines. New employee audits, complaint audits and periodic follow-up audits are also available within the list of services provided to our clients. MCA consultants are required to stay current in all aspects of health care compliance and day-to-day medical practice operations in order to insure the highest quality services are provided.
Legal counsel is often faced with tough decisions as to whether or not overpayments should be reported to the federal government. MCA provides legal counsel with accurate assessments as to whether overpayments have occurred and, if so, to what degree. This information is vital to the self-disclosure decision process.
Billing, Coding & Documentation Education
One of the single most important elements of compliance is education. MCA is able to incorporate its vast experience in representing providers of all medical specialties into a compliance education program which is second to none. Whether the practice has a need for one-on-one teaching or education in a group setting, MCA will tailor a program which specifically meets the needs of the individual client, multi-specialty clinics, hospital medical staffs and medical special societies. A good education program can be viewed as "preventive medicine for the health care practitioner".