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Our Services To Medical Service Providers
We provide the
following services to hospitals, medical groups, and other medical
service providers:
▫ Revenue
enhancement
▫ Account
management consulting
▫ Legal
representation
and recovery in workers’ compensation accounts
Revenue Enhancement
Our revenue
enhancement services can find monies in your closed accounts that
others have missed. We are able to be successful where others have
not because:
1. We
are a legal firm. We know workers’ compensation and civil liability
laws, the dynamics of payment for medical services, and the
litigation process.
2. We
have our own in-house information systems capabilities, as well as
one of a very small number of state-certified, proprietary software
applications, that allows us to integrate our legal and business
know-how into our search for here-to-fore missed revenue.
The
combination of these two key aspects to our revenue enhancement work
not only differentiates us from our competitors, it also gives us
the ability to maximize recovery.
We bear the
entire administrative costs associated with account audits, account
preparation, and account recovery. We also bear the legal costs
associated with any litigation required to ensure revenue
maximization.
Our fees are
contingent upon the amount of recovery, and our clients have found
our contingency fees remarkably refreshing.
Account Management Consultation
Typically,
less than 5% of a medical providers’ accounts are related to
treatment provided to injured workers. Yet, management of these
accounts can take up a disproportionate share of time and resources
from busy staff whose time could be better spent elsewhere.
Just as we
have successfully assisted clients such as the State of California’s
Victims of Crime unit establish effective and efficient account
management processes, we can assist your business office to do the
same.
Our consulting
services include:
▫ Process
design and implementation for in-house management of workers’
compensation account recovery
▫ Review
of and recommendations on current account management processes
▫ Education
and training of staff on workers’ compensation laws as they directly
pertain to medical service providers
Legal Representation & Recovery
In the best of
all worlds, medical providers would be promptly and properly
reimbursed for the services rendered to injured workers.
Unfortunately, this is not always the case. Medical providers can
find their services unpaid or underpaid for a number of reasons,
including:
▫ Denial
of payment, based on disputed injury or disputed treatment
▫ Underpayment,
based on contract vs. fee schedule issues
▫ Underpayment,
based on miscalculations of the fee schedule
▫ Nonpayment,
without a legal basis for denial of payment
When a
workers’ compensation carrier denies or refuses to make payment for
treatment rendered to injured workers, the medical provider’s
recourse is to adjudicate the matter before the Workers’
Compensation Appeals Board.
We are that
uncommon firm that specializes in providing
complete legal representation
to medical
service providers. Unlike some of our competitors, we treat all
referred accounts under the assumption that they will be litigated.
As such, over 90% of referred accounts are fully recovered according
to the official medical fee schedule or the contract under which
treatment was provided.
Our services
include:
▫ Filing
of all legal petitions, including the Application for Adjudication
of Claim, where needed; liens; petitions for payment of penalties
and interest; etc.
▫ Representation
at all hearings, from settlement conferences to Lien Trials and
Court of Appeal
▫ Obtaining
expert opinions and testimonies; conducting depositions of
witnesses; etc., as warranted by the referred case and nature of the
dispute.
As our
services are contingency-based, all costs associated with
adjudication and litigation are covered under our contingency fees.
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