MPK Services--Patient Advocate/Practitioner Advocate

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We hold the hands of patients and practitioners to confirm “…the sky is not falling.” Together, side-by-side we intend to contribute toward resolving healthcare issues, in a positive manner.

Patient Advocate

Background research for diagnosis and treatment options
Research regarding holistic and/or alternative therapy
Facilitation of decision-making regarding patient care and financial responsibility
Medical/Navigational assistance aimed to help the patient clearly communicate and be heard by their practitioner(s). This includes, but is not limited to, quality of life parameters, do not resuscitate orders (DNRs), and any issue that is important to the patient.
Payment negotiations and account management
Dealing with collection calls
Mediation
Medical bill review
Carrier/Payor (insurance) assistance
Prescription cost management
Clarification regarding Explanation of Benefits (EOBs) and the ensuing facility invoice—so patients do not overpay an entity
Mentor patients so they understand their situation from a health insurance representative’s point of view
Health insurance review and teach patients “Health Insurance 101:” The topics addressed could include, but are not be limited to, the following:
- EOBs
- In-network deductibles
- Out-of-network deductibles
- Definitions—for example the definition of the term “donut hole” and the patient’s responsibility
- Health Savings Accounts (HSAs)
- Covered and/or elective procedures
- Patient responsibility
Negotiation options for self-pay patients
Deal with tertiary issues as they arise to take the burden off the patient
Research and connect the patient with nation-wide and/or state assistance programs
Understanding the implications of the Affordable Care Act (ACA)
Native Indian health parameters—contract health, in- and out-of-network options, and patient responsibility

Practitioner Advocate

Are you feeling overwhelmed with your practice’s profit/(loss)? Are you considering early retirement, declaring bankruptcy, and/or becoming a hospital acquired facility? When was the last time you completed a chargemaster evaluation? Do you have questions pertaining to the viability of a capital purchase? Are you considering other medical models—becoming a Concierge practitioner?

It never ceases to amaze us that practitioners and/or testing facilities personnel do not annually evaluate their chargemaster and its relations to each years resource-based relative value scale (RBRVS) rates connected with their most commonly used Current Procedural Terminology (CPT) codes. When we evaluate a facility and note that the reimbursement rates are above the charges, this is a flashing neon sign indicating chargemaster disregard. Do you know if you are using 2014 RBRVSs?

We can easily perform a chargemaster analysis to discern if you are being reimbursed appropriately. Moreover, for other questions and/or concerns, an investigation can be completed using any of the following methodologies:

Chargemaster analysis
- To perform healthcare related analysis, Dr. M also possess CPT, DRG, ICD-9, ICD-10-CM (for diagnosis), and ICD-10 PCS (for procedures) code knowledge
Literature review
Quantitative analysis
Data diving
- Historically, Dr. M has used the following software, online tools, and/or platforms to assist in analysis: FoxPro, SPSS, SAS, SMS Med Series, COMPdata, OAHHS, TSI, Bosanova, AS 400, Easytrieve, and Excel. She was Data Shaping certified in 2008.
Pro forma creation--this requires financial analysis
“Responsive” and/or “Naturalistic” evaluation