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MCare Solutions  |  Capio Partners
MCare Solutions

MCare Solutions, Inc.
www.mcare-solutions.com

MCare was the first company to provide transfer DRG reimbursement recovery services and has since been emulated by a number of others.

MCare Solutions, Inc., a privately held company, was founded in September 2005 by David Jupp, a former patient financial services director and revenue cycle manager of 30 years in a variety of hospital settings. MCare has expanded its service offering to include Medicare Advantage, Tricare and Inpatient Rehabilitation transfer DRG review, and most recently, 3-Day Payment Window Recovery services.

To date, MCare has reviewed and analyzed over 5 million discharges and is responsible for more than $50 million in positive differential reimbursements to client hospitals. MCare’s clients have included for-profit and not-for-profit hospital systems, as well as individual community hospitals, ranging in size from 400 to 7100 beds, and dispersed from Alaska to Florida.

Additionally, MCare was the firm responsible for the CMS decision issued in February 2009, allowing for retroactive review of Transfer DRGs in all 50 states.
 


TAKE NOTE

After more than 18 months of discussion, MCare Solutions, Inc. has successfully influenced The Centers for Medicare and Medicaid Services (CMS) and their respective Fiscal Intermediaries (FIs) to allow multi-year retroactive review and reimbursement of transfer DRG claims in all states.

     

“MCare has done a great job for us and has identified issues that have resulted in material new reimbursements. Their process is well defined and it has been relatively easy for the HIM and PFS departments to provide needed information to them. I would highly recommend them for your organization.”

Vice President Financial Operations
Catholic Healthcare West

“Outsourcing Transfer DRG retrospective reviews to MCare Solutions was a great decision for us... one I’d recommend to anyone considering what to do about potential recoveries in this arena. They are great to work with, delivering significant results to our organizations without burdening us with requests for assistance, and providing all the detailed information we need to see where and how recoveries were realized.”

System Director Reimbursement
CHRISTUS Health

Capio Partners

Capio Partners, LLC
www.capiopartners.com

Launched in 2007, Capio Partners, LLC (Capio) specializes in buying and collecting self-pay receivables from hospitals and their affiliated organizations. 

Capio’s headquarters are in Duluth, Georgia, a suburb of Atlanta, and operations are based in the 30,000 square-foot call center in Sherman, Texas, located just outside of Dallas. The call center, a former Cigna office, currently houses some 100 representatives with plans to expand to 200 representatives by the end of 2010.

 


TAKE NOTE

If collection efforts are continuing on hospital-owned accounts, even via third-party collection agencies, that hospital is very likely out of compliance. 

The only way to recoup additional money (from self-pay Medicare and Non-Medicare receivables) is to sell the receivable.

     

News regarding CMS Rules Compliance
Hospitals are selling the self-pay portion of the Medicare receivables along with Non-Medicare accounts they have charged off. This is the only way to take advantage of any remaining value for the accounts and remain in compliance with CMS regulations.

The Centers for Medicare and Medicaid Services (CMS) rules state that a hospital may not benefit from future collection efforts once an account has been written off to bad debt. “In no case is an unpaid Medicare account which is in collection, including at a collection agency, an allowable bad debt under the regulations...It is Medicare’s policy not to reimburse hospital and non-hospital providers for Medicare bad debts while an account is at a collection agency.”
CMS, Clarification of Medicare Bad Debt Policy/Bad Debt Policy Related to Accounts at a Collection Agency, May 2, 2008

When a receivable is deemed uncollectable, the hospital MUST be finished with ALL collection efforts. At that point, the hospital may not have a collection agency pursuing the outstanding receivable.

 
 
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