Hospitals and Health Systems

Parrish Law Offices works with more than 100 hospitals and health systems across the United States, ranging from academic medical centers to community hospitals.

Addressing Claims Denials and Minimizing Audits

According to industry experts, 25-30% of hospital claims are rejected. These denials routinely cost facilities 5-10% of net patient revenues.

Moreover, payers typically view significant levels of denied claims as supporting decisions to audit facilities. Thus, denied claims are a “double whammy,” costing facilities revenues and increasing the likelihood that they will be subject to audit.

Yet, government reports state that only 2% of denied Part A Medicare claims are appealed.

We are one of the top filers of appeals before the Office of Medicare Hearings and Appeals (“OMHA”); we have participated in more than 1,000 cases.

Through these appeals, we have succeeded in (1) recovering reimbursement on previously-denied claims, and (2) establishing favorable claims treatment going forward, thus ending the need for further appeals.

Based on our experience, we often are able to focus on a targeted number of procedures for which hospitals are being denied meaningful reimbursement. This targeting allows us to pursue recovering the greatest amount of denied reimbursement in ways that maximize efficiency and minimize hospital personnel time.

Thus, in working with us, hospitals can gain immediate and long-term value, while freeing personnel to focus on providing high-quality patient care.

Resolving Audit Matters

Most hospitals, regardless of characteristics, are reporting RAC audits. During 2012 alone, RAC audits targeted $6+ billion in Medicare payments.

In addition, the volume of medical records requested by RAC auditors jumped 80% during 2012.

Yet, only 40% of RAC denials were appealed in 2012, even though the value of denials that hospitals overturned through these appeals was $100+ million.

We have successfully handled multiple RAC, as well as other kinds of, audits. We use our extensive experience handling OMHA appeals and, where it makes sense, we also use negotiations to – again – both successfully resolve current audits and minimize audit issues going forward.