Our Experience
Service Excellence, Health Confidence
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PROJECT
Project
- Streamlined revenue cycle processes for enhanced financial stability.
- Customized training programs for physicians and staff.
- Compliance audits to mitigate risks and ensure regulatory adherence.
- Transparent and motivating compensation models for physician groups.
Litigation
Litigation
- Assistance in resolving payer disputes and recovering denied claims.
- Expert testimony and documentation analysis for malpractice cases.
- Audit defense to address OIG findings and reduce penalties.
- Support in compliance challenges for surgical centers and behavioral health facilities.
PUBLICATION
Publication
- Articles on denial management, compliance, and revenue optimization.
- Guidance on navigating RVU-based compensation models.
- Step-by-step resources for preparing for OIG audits.
- Insights into emerging trends in healthcare billing and reimbursement.
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.
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.
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.
A behavioral health center approached us for a compliance audit. Through detailed chart reviews and staff education, we identified areas for improvement and implemented strategies to maintain regulatory standards seamlessly.
Our team conducted targeted training for a group of 50 physicians and staff, focusing on accurate documentation and evaluation & management (E&M) coding. The result? Improved compliance and significant reduction in coding errors.
We worked with a multi-specialty clinic to revamp their revenue cycle management. By conducting a thorough fee schedule review and denial management analysis, the clinic achieved a 20% increase in clean claims submissions and reduced payment delays.
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.
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.
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.
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.
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.
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.
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.