We work with physicians, hospital administrators, practice managers and administrators to facilitate the best decisions concerning operations, growth, and profitability. Whether you’re trying to decide on the best compliance strategy, buying and managing physician practices, expanding your practice, or facing any of the myriad challenges associated with healthcare reform, we are well equipped to provide the sound guidance you need. Turn to us for solutions.
Our areas of expertise include:
- Hospital Physician Relations
- Medical Practice Governance
- Practice Establishment
- Practice Improvement
- Valuation Services
- Regulatory Compliance
Click on the above for more detailed information.
- Nancy G. McConnell, CHC, CPC
- Barbara J. Grant, CPA, AIBA, CVA
- Lori Foley, CMA, CMM, PHR
- Darcy Devine, AVA, AIBA
- Terika L. Haynes, MHA
- Allan L. Kennedy, MBA, MPH, FACHE
- Tynan P. Olechny, MBA, MPH
- Valerie G. Rock, CPC, ACS-EM, CHC
- Barbara D. Stahura, MPA
- Allison P. Wilson, CMPE, PHR
- Simone N. Barker, MPH
- M. Tracy Pope, CPC, CHC
- Robert Mundy, CPA, ABV, CVA
- Briana Gordon, MBA
- Emma Miller, AVA, AM
- Will Hamilton, MBA, AVA
- Jeff List
- Madhavi Perumpalath, CPC, CGIC, CPMA
The Proactive Appeal
Opportunity – Help an attorney and his physician specialist client navigate the appeals process for an audit that began as a Medicare fraud investigation.
Process – Coordinated a proactive approach to alleviate the identified problem in order to shift the focus of the investigation from fraud to overpayment.
Result – The carrier accepted roughly $13,500 rather than the $151,000 requested by the fraud unit.
AHA Moment – After a brief review of the billing, we quickly identified the problem. We immediately conducted training to educate the provider on the proper way to bill, and determined the overpayment directly related to the review.
The Story – We helped an attorney and his physician specialist client navigate the appeals process for an audit that began as a Medicare fraud investigation. The agency, a Program Safeguard Contractor (PSC), which initially requested the records, focuses on fraud investigations. Therefore, our first task was to determine if the billing was improper and intentional. We quickly identified the problem, and interviewed the physician to assess the root cause of the aberrant coding pattern. A gross misunderstanding of the code range was apparent, while intent to defraud was not. We immediately conducted training to educate the provider on the proper way to bill, and determined the overpayment directly related to the review. We then assisted the attorney in writing a letter to the agency that was accompanied by a check in the amount of the overpayment. The PSC denied it, but said that it would send the check to the local carrier and that we could appeal to them as well. We did, and they accepted. The carrier cited the proactive approach to our corrective action as the reason they were accepting our payment as payment in full. In the end, the carrier accepted roughly $13,500 rather than the $151,000 requested by the PSC.