Denials & Appeals

CMS Takes Steps to Reduce Medicare Payment Error Rate... 


"Topline Healthcare’s pilot was the first of this kind to demonstrate a reduced claim submission error rate (54% to 1%)." — CMS

With our CMS approved systems and Codeable LanguageTM, software, not only will you meet CMS requirements by getting it right the first time, but you can also substantially reduce the hassle, time and expense that you are spending on denials and appeals.

Q:  What do you do with the denials and appeals that you are currently facing?  And how do you alleviate the additional time and expense that you are spending to keep up with this problem?  


A:  Topline Healthcare is an industry leader in turning around denials and appeals. We have a proven track record of over 3,400 wins before the ALJ (Administrative Law Judge), and we are here to do the same for you.

$:  We are performance based.  This means if you don't get paid, we don't get paid.  Therefore, you have nothing to lose and everything to gain.


Under the new regulations set by CMS, providers are now liable as well as the facilities for payments deemed unacceptable. This means providers are no longer paid if the bill is denied.  Also, providers now are responsible, in addition to the facilities, for returning monies paid if your bill has been audited is deemed inappropriately paid.

With our extensive history and expert understanding of the denials process, we review your denials from all aspects, which includes a thorough investigation that covers all-encompassing clinical and technical angles.  We address your denials in a way not found in appeals typically written by most facilities, and then write customized winning appeals on your behalf.


We have won over 3,400 appeals before the ALJ.  The reason for our repeated success is our proven, all-inclusive approach.  Our team of highly knowledgable subject matter experts skillfully sight current regulations, laws, clinical indications, and CMS guidelines.  This gives you an innovative edge in getting paid for the hard work you do.


Our win-win proposition is based in repeated success that has helped recover multi-millions of dollars for providers, hospitals and healthcare facilities.  Remember, if you don't get paid, we don't get paid.  


GET MORE about the upcoming changes in healthcare in this FREE REPORT — 

"Medical Billing is in the Dark Ages" claims Page Winfield Cunningham, The Washington Examiner's healthcare correspondent, in a May 7th, 2015 article and one of many about the problems facing the healthcare industry. Mark Kimmel, Ph.D.,  co-founder of Topline Healthcare and leading expert, with over 20 years of experience in healthcare and its related research, sheds light and sees hope in his publication, The Tidal Wave of Change in Healthcare Today.  Mark not only provides a masterful analysis of why "hospitals and providers are struggling to stay afloat," but he also shows the correct path with a proven business model to bring healthcare providers kicking and screaming into the 21st century.

I endorse enthusiastically this scholarly, substantive and enlightening essay.

— Oscar Mann M.D., FACP, FACC, FCCP

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