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Partner Spotlight: Medical Present Value (MPV) at University of California San Diego (UCSD)
"It almost instantly validated what we had long suspected about our contracts and reimbursement. We can now identify underpayments very efficiently instead of having to hunt and peck for them."
Tia Goodrich, UCSD's executive director of business services
Situation
Like most medical groups, UCSD has seen steady erosion in the proportion of full charges collected for submitted claims. Although some of this decline results from tightening reimbursement rules and rates, UCSD in 2002 (prior to implementing MPV PhynanceTM) uncovered long-standing systematic payment errors on one of its larger health plan contracts.
Challenge
Manually documenting payment errors consumes many hours of effort, and UCSD didn't have the staff to do so on a regular basis. That made it difficult to identify or recover underpayments. "We needed a more programmatic way of managing contracts," said Tia Goodrich, UCSD's executive director of business services.
Implementation
MPV Phynance was implemented at UCSD under the direction of the MPV project team and Global Works Consultant Marianne Terzick. Working closely with UCSD and MPV, Global Works implemented the Global Works Phynance Interface and assisted UCSD with the intricacies of data mapping between systems.
Solution
An initial evaluation using Phynance identified extensive underpayments. "It almost instantly validated what we had long suspected about our contracts and reimbursement," Goodrich said. UCSD began implementing Phynance with the Global Works Interface in mid 2003, and within six months was able to accurately value more than 80 percent of line items for commercial contract claims — without adding staff or new computer hardware.
"We can now identify underpayments very efficiently instead of having to hunt and peck for them," Goodrich said. "Payment trending is part of the program, which helped us find some large, systematic, underpayment problems, including several contracts that were paying carve-outs incorrectly." Like most practice management software, UCSD's system was not designed to apply all contract payment rules as Phynance does.
Results and Return on Investment
In the first six months of appeals based on MPV data, UCSD recovered more than $150,000 in underpayments, putting the group on target for its projected ROI, including the staff time for loading contract terms and customizing the interface with its practice management system, Goodrich said. In the first eight months of operations, Phynance identified more than $1 million in contract variances or about 8.6 percent of UCSD's net revenues for commercial contract services — much of which Goodrich has appealed and expects to collect. "We now are able to understand and manage our contracts better," she said.
About Global Works and MPV
Global Works and MPV formed a strategic partnership in 2000. Global Works provides the MPV client base with the MPV Interface for practice management systems and the client side consulting services to assist clients in their implementation and use of the MPV Phynance solution. |
