Yes. Our work focuses on payer behavior, reimbursement rules, plan language, and appeal strategy rather than specialty-specific clinical services. We work with providers across many specialties, including chiropractic, physical therapy, surgery, orthopedics, behavioral health, and others.
4. Do you handle Medicare, Medicare Advantage, Medicaid, TRICARE, Workers' Comp, and PIP claims?
Yes. While the governing rules may differ, the process of identifying the payer's reasoning and building a targeted response applies across government and commercial programs.
5. Do you provide billing, coding, or credentialing services?
No. We are not a billing company, coding service, or credentialing vendor. Our focus is reimbursement defense, appeal strategy, underpayment disputes, recoupment defense, audits, and revenue recovery.
6. Do you provide CPT coding reviews or documentation audits?
No. However, if you're being audited, we may be able to help you draft your audit response and reimbursement dispute so that documentation is reviewed in the proper context in accordance with applicable rules and requirements, rather than the payer just looking for a reason to deny or recoup.
7. What types of denials can you help with?
Examples include:
Medical necessity denials
Experimental or investigational denials
Prior authorization denials
Benefit denials
Timely filing denials
Non-covered service denials
Downcoding
Bundling issues
Out-of-network repricing
Underpayments
Recoupments and offsets
Audit findings
Other complex reimbursement disputes
8. Can you help if I've already appealed?
In some cases, yes; provided that it's still within the appeal window and a second-level appeal is allowed. However, for the best possible chances at recovery, we recommend retaining us immediately on any hard denial instead of taking your chances with your own appeal.
9. What if I don't have the member's plan document?
That's common. We can often evaluate the situation using the available information and discuss what additional documentation may be helpful.
10. What is included in a case?
A case generally includes review of the denial or underpayment, identification of the payer tactic at play, appeal drafting, reimbursement defense strategy, and follow-up or escalation guidance related to that specific issue.
11. What makes a case complex?
Complex cases may involve multi-level appeals, high-dollar claims, recurring denials, multiple affected claims, extensive documentation, contract interpretation, regulatory analysis, or advanced escalation strategies.
12. How much do your services cost?
Fees vary depending on the value, complexity, and scope of the matter. Depending on the case and the services you request, the price may be structured as a flat fee, a reduced up-front fee plus a 10% recovery fee, or a contingency-based recovery fee.
13. What is the Reimbursement Defense Assessment?
The Reimbursement Defense Assessment is an initial review designed to determine whether a claim is worth pursuing, identify the likely payer tactic involved, and provide recommendations for next steps.
14. What happens if you don't think I have a strong case?
We'll tell you. We don't recommend additional services simply to
generate fees. If we don't believe further action is likely to produce
meaningful value, we'll say so.
15. Do you communicate directly with payers?
Yes. For clients using our done-for-you revenue recovery service, we
can communicate directly with payers and pursue available
escalation paths on the provider's behalf.
16. Can you help with audits and refund demands?
Yes. We assist with audit response strategy, recoupment defense,
refund demand disputes, and related reimbursement dispute issues.
However, we don't provide CPT coding reviews or documentation
audits.
17. Do you guarantee payment or recovery?
No. No one can ethically guarantee a specific outcome. We provide
strategy, analysis, appeal drafting, and recovery efforts designed to
place providers in the strongest possible position, but outcomes
depend on the facts of each case.
18. Why should I contact MCA before filing an appeal?
Because appeal opportunities are limited. Once deadlines pass, or
important arguments are omitted; recovering the revenue can become
much more difficult. A strong strategy is usually most effective
before appeal rights are exhausted.
