Here To Help
IPA Solutions was formed to help answer these questions by focusing on the management needs of single and multi-specialty IPAs as well as hospitals paying specialty provider claims for uninsured or underinsured patients.
Contracting
IPA Solutions identifies areas of financial, operational, and legal concern to discuss with you and/or your legal counsel to help you negotiate a win-win agreement with the health plan, IPA, or Medical Group. These services typically minimize your legal fees and operational costs while maximizing your reimbursement.
Adjudication Guideline Development
IPA Solutions knows how to create and apply claims adjudication guidelines, using national and proprietary formats, to help prevent system gaming and support a fair compensation distribution methodology that maintains contract profitability for your organization.
Quality Assurance/Utilization Management Program Development
IPA Solutions can facilitate the completion of a formal quality assurance and utilization management plan, including how to monitor and demonstrate plan effectiveness through the capture and reporting of quality indicators.
Rate Development
IPA Solutions can assist you evaluate if the rate being currently being paid or being offered to you is fair for the services you are providing. While this sounds simple, many capitated agreements can be very difficult to analyze and administer because of the complexity of different responsible payer organizations, different payment methodologies and/or rate differentials by place of service or service category. We have the ability to model any contract, no matter how complex.
Capitation Distribution Methodologies
IPA Solutions can also help your group implement a distribution methodology that works in concert with your claims adjudication guidelines to align provider incentives towards your organization’s quality and utilization management goals.
Accounting Services
IPA Solutions can assist in the creation of clearly defined bookkeeping and accounting tasks, including provider claims payments, accounts payable, payroll, and coordination with your accountant for tax preparation services.
Challenge
| A 35 physician specialty IPA with a capitation risk contract. |
This client had a previous TPA for several years and approached IPA Solutions looking for responsive service, enhanced capabilities, and a competitive rate for performing their claims management services. The client has a shareholder pool distribution using a historical average methodology, and additional sub fund pool distributions for coordination of benefit claims, sub-contractors, and medical supplies.
IPA Solutions was able to exceed this client’s service expectations by providing the service transfer with no interruption, expediting the adjudication cycle and developing sophisticated management reports for use in utilization review and quality assurance. IPA Solutions did all this while cutting the client’s claims management expenses by 20% per year.
Challenge
| A community hospital with a high population of uninsured patients. |
The specialist physicians who practice at this hospital complained that they were having financial difficulties in continuing to provide uncompensated care. The hospital decided that in an effort to help the physicians they would pay the claim of the uninsured patient if the patient failed to make payment. The hospital was initially using an internal clerk to pay the specialist claims at the local Medicare rate, but the hospital was finding that as the volume grew they not only had an operational problem but a growing financial burden as well.
IPA Solutions stepped in and took over this process and implemented the following changes: (1) setting up a budgetary pool of monies to be used in paying these claims, (2) actually adjudicating the claims applying edits against inappropriate billing, and (3) trying to recoup the expended money from the patient or any coverage that may be available to the patient. These steps saved the hospital money, allowed the hospital to plan and budget for the expenditure, and freed the hospital from the operational burden of paying claims so that they could focus on their core business of providing care to the community.
Contact us today and let’s build something.
Office
772 North Main Street #365
Tooele, Utah 84074
Hours
Mon-Fri: 9am – 5pm
Via Email
information@ipasolutions.com
Via Phone
Tel: 888.667.2250
Fax: 435.249.0050