Has your client received a repayment demand?
If you’re an attorney who’s client has received a recoupment demand letter from Medicare, Medicaid or a private payer, you’ve come to the right place.
Many physicians are caught in the crossfire of the injustices prevalent in our current healthcare system. Government payers (Medicare and Medicaid) are providing financial incentives to contract auditors based on the amount of money they recoup. Equipped with sophisticated tools that they might not fully understand, these commission-based auditors attempt to recoup revenue that was legitimately earned by hard-working physicians. Commercial payers are riding the wave of this trend with their own recoupment programs. Our top priority is to help you protect physicians who have to contend with the increasingly systematic and aggressive tactics that some insurers use to improve their own profitability.
A winning strategy includes expert auditors
Gaining access to auditors experienced in the audit appeal defense process greatly increases the odds of successfully getting the demand reduced or eliminated entirely. The attorneys we serve had grown to trust our leaders as an extension of their defense team and gain access to a team of experts in auditing, coding and documentation, audit appeals and defense, medical necessity and regulatory compliance. (See team qualifications and credentials.)
A History of Success
$11 million Medicare Refund Demand – Reduced to $3,000 and Payment Suspension Lifted
$14 million Medicare Refund Demand – Reduced to $233
Provider Served with 125-Year License Suspension – Case Dismissed and Provider Reinstated
Unbiased fact over interpretation – the missing link
There are many auditors out there who wrongly believe that medical coding is based on interpretation. This mistaken mindset becomes obvious, and actually gets magnified, when working in medical audit appeals defense. There are specific guidelines for medical coding and documentation, and auditors who use interpretation as an excuse for ambiguity in their auditing assessments and reports have no place in a defense strategy!
Our team works from fact. They strictly adhere to the most current guidelines and deliver reports/results that can be fully defended. They are protecting thousands or millions of dollars of physician revenue and leave no room for argument as to the medical necessity of services provided. You can rest assured that the audit has been performed in a way to help reduce the recoupment demand to as close to zero as possible!
Build your rock-solid defense strategy for your client
We arm you with facts to support a winning defense strategy. The audit reports you receive will demonstrate to the payer a deep understanding of the very system that is being used to demand revenue that was rightfully earned by your client. You’ll have no unexpected surprises and we work hard to ensure your case moves as smoothly and quickly as possible.