Doctors & Hospitals

First-class consulting, auditing, education, and coding support services to help you recoup costs.

Hospitals have become
the front line.

1 in 5 doctors have been furloughed or taken a pay cut as the coronavirus pandemic hit hospitals. You have revolutionized your day-to-day operations to save lives and you have done a wonderful job.

Who is helping save your main lifeline: revenue?

You do what you do best, provide care. We want to help you by doing what we do best. We can help you collect your hard-earned money.

Denials by the Numbers

America’s hospitals are committed to quality patient care and take compliance very seriously. Yet, necessary care payment denials are common and amount to lost costs, further aggravating the widespread operational problems. 

%

of claims are denied at an average 350-bed hospital

%

of revenue cycle management expenses are attributed to denial related issues

Billion dollars in initially denied claims for healthcare providers annually

%

in denial write-off adjustment net revenue

Our Services

Denials

Payers use more Artificial Intelligence which causes and contributes to higher denials. The inability to overturn incorrect and/or questionable payer rejections can become expensive to providers. Appealing to your insurance company takes time and requires intricate clinical documentation requirements and standards understanding and knowledge. Additionally, denials are costly to resolve, on average, $118 dollars per claim to appeal.

We utilize highly proficient, seasoned clinical auditors who are skilled at reviewing appeals and can help you immediately by driving much needed revenue and enhanced cash flow. Without adding stress to your team, we review and evaluate records and help you respond to the insurance company.

To get started, we will take a precursory review of your denials, this is complementary. Within a week, we will develop a plan and low-cost solution for your team to add directly to your bottom line.

Audits

  • Remote coding audits and remote coding for inpatient visits, outpatient surgery, emergency room, injection/infusion, and ancillary records
  • Onsite coding support and education for injection and infusion coding and updates
  • Policy and procedure review and audits

Existing Programs

  • A comprehensive review of current policies and procedures to identify opportunities
  • Support to improve current procedures to leverage opportunities
  • Customized training for staff and ongoing support

New Program Development

  • Assessment of current procedures
  • Suggestions on implementation of improvement plan and perform training
  • Providing ongoing support and follow ups

    Targeted Solutions

    We are not the one-size-fits-all consulting company that looks to land a client and stay there for a while. We efficiently work with our clients as a trusted partner when we are most needed. Proactively developing plans and methodologies to avoid denials and other issues they are facing rather than just helping fight them.

    Our Experts

    Top of the class.

    Laurie McMillan

    Laurie McMillan

    Director of Healthcare Payment Policy Integrity

    Brian Boyce

    Brian Boyce

    Director, Risk Adjustment Integrity Group

    Eric Rubenstein

    Eric Rubenstein

    Director & Former OIG Special Agent

    Let's Talk!

    No obligations, no hassle’s, no spam. Just a chat with a trusted partner for the nation’s most prominent hospital systems.

    Corporate Office

    1885 Lee Rd
    Winter Park, FL 32789

    813.569.2352
    888.722.6059