In the complex landscape of modern healthcare, providers increasingly face actions such as overpayment demands and pre-payment reviews, initiated by both government agencies such as the Centers for Medicare & Medicaid Services (CMS) and private payors. These audits can be triggered by various factors, each serving as a potential red flag for payors. Unusual billing patterns that deviate from those of similar providers often attract attention, along with frequent usage of highly reimbursed codes which may suggest upcoding or unnecessary services. As insurance companies employ advanced data analysis tools to identify outliers in billing trends, providers must be prepared to navigate the resulting scrutiny and investigations, which can potentially escalate into legal complications.
In this challenging environment, the value of experienced legal counsel cannot be overstated. Frier Levitt has demonstrated remarkable success in navigating these complex issues. What sets us apart is our team approach, combining the experience of seasoned healthcare attorneys with expert medical coders. This multidisciplinary strategy allows us to address both the legal intricacies and the technical aspects of medical billing and coding, providing a comprehensive defense for our clients. Frier Levitt’s unique position in the industry is reinforced by established relationships with major payors’ legal departments, allowing for more efficient dialogue and negotiation.
Frier Levitt’s track record highlights the effectiveness of our approach:
- Significant Overpayment Reduction: In one notable case, we secured a reduction of over $1,500,000.00 in an overpayment demand initiated by a managed care organization. By leveraging the expertise of a professional coder to challenge alleged documentation discrepancies, negotiating with opposing counsel, and contesting the findings, Frier Levitt achieved a significant reduction on behalf of our client.
- CMS Audit Success: In another matter involving the CMS, Frier Levitt successfully reversed 75% of the audit findings, leading to more than a 90% decrease in the original overpayment demand. This substantial reduction was accomplished through a meticulous appeal process, and the combined efforts of Frier Levitt attorneys and expert coders. Together, we clarified and strengthened arguments regarding medical necessity and alleged documentation insufficiencies, effectively challenging the audit’s initial findings.
Frier Levitt has also had considerable successes in terminating burdensome pre-payment reviews, which severely impact a practice’s cash flow and carry the risk of an extrapolated overpayment demand.
- Rapid Pre-Payment Review Resolution: In one case, Frier Levitt ended a pre-payment review within just two months of engagement. This rapid resolution involved vehemently challenging denials, objecting to incorrectly cited policies, and engaging with the payor’s legal department. The swift termination of the pre-payment review restored the practice’s financial stability, allowing it to refocus on patient care rather than administrative burdens.
- Termination of Prolonged Pre-Payment Review: In another case, Frier Levitt successfully terminated a pre-payment review that had stalled for months before our involvement. We pushed for transparency in the results, prepared an appeal, worked with the client to improve documentation to increase the chance of submitting clean claims, and were able to stay the pre-payment review before eventually successfully terminating it.
Frier Levitt’s successes in reducing overpayment demands and terminating prepayment reviews highlight the firm’s effectiveness in handling the legal challenges posed by healthcare audits. Through collaboration between attorneys and expert coders, relationships with payors, strategic arguments, and skilled negotiation, Frier Levitt has achieved remarkable outcomes for its clients.
If you or your practice are facing a healthcare audit, reach out to an attorney at Frier Levitt today to protect your practice’s interests and navigate this complex healthcare landscape with confidence.
