Mpowermed™ Inc. Drives “Monumental” Shift in Insurance Practices

With Mpowermed’s persistence to principles, it guided a system-wide change, nationally, to processing claims for ‘brain/bone metastases’ and the associated treatment and technique to be performed at a major third-party medical claims processor, or Utilization Management Program working for nearly a year to get a large insurance provider’s Utilization Management Program to change how they handled certain coding and approvals for procedures and treatments.

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“Revising a company-wide process was a monumental shift,” she adds, “While I don’t believe that we are the only medical management company experiencing this," Ms. Winington say, "I do believe we’re one of few that will go to these lengths.”

Mahwah, NJ (PRWEB) June 20, 2014

Once considered back-room services, medical management and billing organizations that want to flourish in this highly competitive industry need to become strategic partners to providers. They also need to become advocates for patients and act as “friendly” problem solvers for insurance companies, says Lisa Winington, Director of Revenue Cycle at mpowermed, inc., a full-service practice management and medical billing company. “It’s a delicate balancing act and our company and its employees have years of experience to do this process correctly for the best return on investment,” she says.

Of the many success stories Ms. Winington has achieved at Mpowermed, she spoke about one striking accomplishment: how the company made a system-wide change to processing claims at a major third-party medical claims processor, or Utilization Management Program. The company worked nearly a year to get a large insurance provider’s Utilization Management Program to change how they handled certain coding and approvals for procedures and treatments. This system-wide change began when one patient needed treatment and was facing thousands of dollars in out-of-pocket medical bills. Insurance companies use diagnosis and coding procedure “worksheets” as part of the approval process. “In this worksheet there was no accounting for ‘brain/bone metastases’ and the associated treatment and technique to be performed,” says Ms. Winington.

Convincing a major Utilization Management Program, which processes claims for major insurance companies such as United Healthcare, Blue Cross & Blue Shield and Aetna, to change authorizations and the precertification process was no easy task. But without a revision, the patient, as well as many others facing similar circumstances, could not receive the physicians plan of treatment and the insurance companies should not dictate the treatment.

“We had to work with senior executives, at the Utilization Management Program, including the chief medical officer, the CEO and the president,” Ms. Winington says. “Revising a company-wide process was a monumental shift,” she adds, “While I don’t believe that we are the only medical management company experiencing this, I do believe we’re one of few that will go to these lengths.”

Providers already stretched for time will have to be more meticulous in keeping records, as well as managing their practices. These changes are creating more opportunities for medical management companies. There’s been a steady increase of competition, given the opportunities and the low barriers to entry, observers say. But not all medical management and billing companies are the same: Mpowermed prides itself on having experienced business management experts that go the extra mile.

With the new medical billing codes and regulations barreling down on providers, Ms. Winington is confident the company’s collective years of medical management experience can help providers successfully navigate the industry-wide changes, with little to no business disruptions. In addition, Mpowermed also offers qualifying providers a FREE Electronic Health Records!

Mpowermed, inc., established in 1998 and based in Mahwah, NJ, is a full-service medical practice and project management company. Mpowermed’s team of clinical and administrative staff will customize services to meet the needs of a growing or fully-established practice. Mpowermed offers a turnkey practice management solution including a broad range of the finest services in the industry to meet today’s challenging healthcare environment. Mpowermed specializes in medical billing and collections, physician credentialing, Medical Physicist, Dosimetry & Radiation Therapist Staffing (Full Time or Temporary), Employee & Physician Benefits Management (Human Resources), General Bookkeeping, Practice Management, missed charge audits & tumor registry. Mpowermed’s goal is to partner with the practice administration for peak efficiency through the use of its professional team to ensure successful outcomes for the practice.


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