Automatic Collection - Effortless Returns.
MCAG makes sure that clients do not miss deadlines or fail to
collect on refunds that they are due under these Settlements.
MCAG will maximize the return that the client is entitled to
collect. Once the physician/practice enrolls with MCAG (one time
only) MCAG will automatically file all returns/claims for
physicians for the remainder of all settlements at they come
due. MCAG files the claims, collects the money and returns the
money to the practice after they extract their percentage fee.
MCAG only collects a fee as a percentage of what they actually
collect for the practice.
Contact us to learn more about
collections and returns.
Settlements
AETNA FLORIDA Emergency Services and Care Settlement
Who is eligible for this settlement:
Any and All physicians, physician groups, or physician
organizations who provided emergency services and care in
Florida to any HMO plan members and who were paid by Aetna for
those services outside of any contract or agreement during the
class period (June 3rd, 2003 to December 15th, 2008).
What is this settlement about:
The Class alleged that Aetna violated Sections 641.513
Florida Statutes, a statue governing “usual and customary”
payments by Florida HMOs to physicians who rendered Emergency
Services and Care to HMO plan members.
For each claim you properly re-submit through the settlement
process, you should receive the difference between 125% of
Medicare Rates (Aetna’s historical allowance) and 238% of
Medicare Rates (the agreed upon settlement amount).
How do you file:
You can choose to file on your own, or you can use MCAG to
file on your behalf. To file on your own, you must submit a
claim form to the settlement administrator by May 4th, 2009. At
this point, Aetna will use its “Best effort” to determine how
much they underpaid your practice for the time frame of June
2nd, 2007 through December 15th, 2008, and send you payment.
If you choose to use MCAG to assist you in filing, you must
request a MCAG client services contract and submit it to MCAG no
later than April 27th, 2009. At this point, an MCAG
representative will contact you to gather the information
necessary to file a claim. MCAG will use the billing information
(Provided by you, or your billing company) to audit Aetna’s
“Best Effort” calculation, and perform the necessary appeals to
ensure that you receive what is rightfully yours.
MCAG will also use the billing data to determine if you are
eligible to submit claims that were underpaid before June 2nd,
2007. To do so, the settlement requires the class member to
submit supporting documentation, which MCAG will recreate from
the billing data when possible, and work with your practice to
retrieve other documents if necessary.
HMO Settlement Filing
The HMO MDL lawsuit is one of the largest class action
lawsuits ever brought to Federal Courts in this country. The
lawsuit named ten (10) of the largest managed care payers in the
country and alleged payment practices including the down-coding
and unbundling of claims. The lawsuit sought civil damages
(financial awards and changes in business practices) and RICO
damages (criminal damages for triple the financial relief) from
Aetna, CIGNA, Prudential, HealthNet, Humana, Coventry,
PacifiCare, United HealthCare, Anthem BCBS and Wellpoint.
To date, Aetna, CIGNA, Prudential, HealthNet, Humana, Anthem/Wellpoint
and BCBS have settled and all provided both retrospective
(refunds of about $400 million to date) and prospective (changes
in business practices) relief.
Prospective Relief
While the MDL settlement payouts have been substantial, the
prospective changes required by the Court will have a far
greater impact on future revenues. We are aware of payers who
have not been fully compliant with the changes in business
practices as mandated by the Southern District Federal Court.
This continues to be a big issue for physicians and hospitals
alike.
One way to ensure the rights of your settlement is to make
sure that your contracts include new language consistent with
the mandated changes. In Partnership with MedRecover, MCAG
maintains first-hand knowledge of the new rights and remedies
that physicians gained in the HMO MDL litigation. The class
action lawsuits created a new set of rules for payers. These
changes include specific payment and contracting rules that are
not well-understood by most physicians and hospitals. Most of
these rules will expire over the next three to five years. It is
important for providers to understand what they have gained and
to maintain the appropriate contract language throughout the
settlement period and beyond. These new rules could improve net
revenues by as much as 5% each year over the next several years.