Consulting & Litigation

  • Researching difficult billing, coding, reimbursement issues, and payor coverage requirements your healthcare clients face.
  • Working closely with attorneys to research billing problems and defending audits from Medicare, BC/BS and other payors questioning healthcare provider claims and billing/coding processes.
  • Providing assistance to healthcare providers with the set-up and ongoing operation of Compliance Plans and Fraud Prevention Programs.  We also perform chart audits for coding and documentation issues.
  • Auditing the plaintiff's medical bills to provide your firm with valuable, money-saving information on what is fair payment on involved claims.  Medical claims are audited for usual and customary fees for the geographic area, reviewing the coding used to bill services, and reviewing for medical necessity and standard of care issues on bills from all provider types.  The defense side liability will be less by not paying the plaintiff's medical bills at their billed face value.
  • Provide a review of the medical records related to your medical cases, with a summarization of the records according to your preferred format.
  • We can also provide a medical opinion of the reviewed medical records.
  • We research the medical conditions and procedures involved in your cases for the medical necessity and standard of care for treatment of a particular condition at the time it occurred.
  • Other consulting services, as requested

All of the above services are performed by Registered Nurses, Certified Professional Coders, and other experienced healthcare consulting professionals who have years of coding, billing, clinical, managerial and operations experience.  These services can be accomplished for any type of medical case “ Workers' Compensation, Medical Malpractice, Liability, Disability, etc., as well as numerous Provider Billing Issues.  The owner of the firm is a member of the Nashville Bar Association.