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2007 Accomplishments For Our Valued
Provider Clients
Contract Negotiations
- Negotiated improvements in pricing for all payer agreements for several major multiple and single-specialty groups, resulting in 8% to 12% increases above existing rates for all agreements executed. Also made chargemaster updates and improvements.
- Negotiated double-digit increases in payer agreements for a major multi-specialty clinic, a record in its long history with the payers
- Overturned unfavorable pricing agreement entered into by primary care practice. Increased reimbursement to the practice by approximately $250,000 annually.
- Negotiated initial payer contracts for new practice in Eastern Washington. Standard pricing originally offered by payers because the practice was new and lacked practice history. Results averaged from 8% to 15% higher than standard pricing.
- Reviewed professional and ambulatory agreements for a major local health system, demonstrating areas where "carve-out" contracting could be successfully employed, significant improvement could be gained.
- Identified opportunities for significant improvement in the commercial pricing exhibits of a major Seattle hospital. Currently engaged in renegotiating commercial pricing exhibits.
- Negotiated multi-year, double-digit increase with Blues plan for major specialty group.
- Negotiated 10 - 30% increases over standard range in payer agreements for new Ambulatory Surgical Center.
- Negotiated a 50% increase to existing infusion therapy pricing with a major national payer.
- Negotiated a significant increase to governmental reimbursement received by client.
Revenue Recovery
- Recovered nearly $1 million in wrongfully denied professional, facility fees for care of one acutely ill patient
- Recovered six-figure sum for orthopedic practice that underbilled for bi-lateral procedures, self-insured workplace injury claims
- Recovered six-figure sum for single-specialty clinic that underbilled for labs, diagnostic procedures
- Served as expert witness in litigation to justify higher reimbursement rates to physicians
Practice Formation/Expansion
- Helped form largest ASC in competitive catchment area
- Launched solo practice for physician who left major medical center because productivity pressures were interfering with patient care
- Advised physician on how to eliminate call obligations to hospital while retaining privileges, focus on sub-specialty
- Assisted multi-specialty clinic acquire another multi-specialty clinic
- Assisted single-specialty clinic expand into new geographic area
Payer Audits
- Prevented criminal referral, $450,000 repayment demand in Premera audit of two jointly owned clinics
- Prevented termination, reporting to federal data banks, months of appeal process in Regence audit of primary care physician
- Negotiated reduction of over 60% of Medicare's repayment demand from solo practitioner
- Negotiated reduction of over 50% in L & I's repayment demands in multiple audit cases of solo and small practitioners
Professional Discipline
- Convinced DOH to drop scope-of-practice charge against surgeon
- Convinced DOH to drop wrongful charges of inappropriate touching against physician
- Convinced DOH to cease investigation of allegations of improper billing
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