Case Result: Through Documentation Analysis, Our Healthcare Compliance Lawyers Convinced RAC Auditor to Clear Payment for RFA Procedures

Professional:
Physician

Primary issue:
Our client, a Michigan heart and vascular specialist practice, retained Chapman Law Group to appeal a RAC audit decision to deny reimbursement for 14 radiofrequency ablation (RFA)/ varicose vein procedures, paving the way to deny more in the future. The practice performed a significant number of RFA procedures due to its patient population; for this reason, the practice came under scrutiny as an outlier. The physician and his practice manager took an aggressive stance that the procedures were medically necessary and in compliance with the spirit of the applicable local coverage determination.

Benefits of Using Chapman Law Group:
The Chapman Law Group healthcare compliance attorneys were retained to present the reconsideration to CMS. In reviewing each file, our health care lawyers identified weak spots in documentation, and we obtained additional documentation and statements from the physician. Armed with the additional information, our compliance lawyers drafted a successful appeal. Additionally, we educated the practice on better documentation techniques to avoid future negative audit outcomes.

Result:
The RAC auditor completely reversed the decision and cleared all RFA procedures for payment.

Areas of Law:
Healthcare Compliance
Health Care Auditing

Disclaimer:
This information is a sample of our past results. Prospective clients may not obtain the same or similar results. Every case is different and each case must be evaluated and handled on its own merits. The circumstances of your case may differ from the results provided. The information provided has not been reviewed or approved by the State Bar.