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Payor Issues

Have denied claims?
Payment Suspension?
Recived an Audit?
Help with Compliance?

Support for in-network and out-of-network providers. Payors of all kinds have an obligation to monitor the community for fraud & abuse. Once you receive notice of a payor audit you have an opportunity to review compliance, negotiate any errors and avoid sanctions.
Your team will work alongside ours, from your billing & coding staff to in-house counsel in some cases to do a risk evaluation and analyze your exposure for the audit period.
We take the time to do a full diagnostic and prepare for follow-up activity before we respond. The goal is to prevent soft flags and keep your business flowing throughout the audit process. We believe that open lines of communication are essential for all sides to work through an audit quickly and efficiently.

  • Medicare/medicaid Audit
  • Payment Suspension
  • Rebuttal
  • Commercial Plan Audit
  • Rac Audit
  • Care & Quality Improvement Audit
  • Medicare Appeal
  • Zpic Audit
  • Dea Audit

Our experienced attorneys routinely assist clients in identifying areas for improvement

  • We analyze risk in billing practices
  • We identify documentation and systems that validate a claim
  • We challenge overpayment demands and allegations of fraudulent billing
  • We provide representation on denied claims, false claims or overutilization of services.
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CMS has issued transmittals on how to understand the suspension process. However, even with this guidance, providers and suppliers should take action with qualified counsel to ensure sufficient funds are available to continue operations if a suspension is initiated. In addition, providers and suppliers should be ready to prepare a comprehensive rebuttal that fully addresses CMS’ concerns in order to counter the suspension decision.

Regulatory Compiance

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Corrective Action Plan Implementation

A corrective action plan (CAP) is a step by step plan of action that is developed to achieve targeted outcomes for resolution of identified errors. Our team routinely assists clients with writing, reviewing and implementing effective CAPs.

Policies & Procedures Development

Healthcare providers need to have in place certain policies and procedures in order to allow providers to maintain compliance with the law; assure periodic assessments of areas of risk; and respond appropriately when a breach is suspected or detected. Our most proactive clients develop policies & procedures to avoid audits and red flags.

Audits to Ensure Compliance

We offer a unique opportunity for providers dedicated to compliance to gather critical data by working through guided audit scenarios with highly trained members of our team