Optimizing RVU-Based Compensation Models
This publication examines the intricacies of creating fair and motivating RVU-based compensation structures for physician groups. It offers practical guidance on balancing performance metrics with financial sustainability.
The Evolving Role of Medical Coders in Compliance
Published in a leading industry journal, this article discusses the expanding responsibilities of medical coders in ensuring compliance and mitigating risk. It highlights the importance of ongoing education, cross-functional collaboration, and the integration of compliance into daily operations.
Navigating Denial Management: Strategies for Success
This comprehensive article explores proven methods to tackle claim denials effectively. Covering topics like root cause analysis, tracking denial trends, and implementing corrective measures, it provides actionable insights for healthcare organizations to boost their revenue cycle performance.
Defending a Laboratory Network in Fraud Allegations
A laboratory network faced allegations of fraudulent billing practices. We conducted an independent review of their billing processes, identified the source of errors, and provided corrective recommendations. Our expert report played a pivotal role in dismissing the allegations and restoring the network’s reputation.
Audit Defense for a Behavioral Health Facility
A behavioral health facility undergoing an OIG audit turned to us for assistance. Our team reviewed the audit findings, identified errors in the auditor’s calculations, and prepared a detailed rebuttal. This proactive approach resulted in a reduction of penalties and reinforced the facility’s compliance practices.
Assisting a Physician Group in RVU Compensation Disputes
A physician group faced allegations of misaligned RVU-based compensation models. We analyzed their compensation structures, verified the integrity of RVU calculations, and provided documentation to support their compliance. This evidence helped the group resolve the dispute favorably without penalties.
Resolving a Payer Dispute for a Large Hospital
A prominent hospital was involved in a legal dispute with a payer over denied claims. Our team conducted an exhaustive review of billing records, identified discrepancies, and provided expert testimony. With our support, the hospital successfully negotiated a settlement, recovering 85% of the disputed claims.
Denial Management for a Laboratory Network
A laboratory network faced significant challenges with payer disputes. Our intervention, including denial management strategies and fee analysis, resulted in a 30% decrease in claim rejections within six months.
Compensation Model Development for a Physician Group
We developed an RVU-based compensation model for a physician group, aligning incentives with performance metrics. This project enhanced transparency and motivated the team to deliver high-quality patient care.
OIG Audit Support for an Ambulatory Surgery Center
We provided OIG audit assistance to an ambulatory surgery center, ensuring accurate reporting and documentation. Our support helped the center avoid potential penalties and strengthen their compliance protocols.