DENIAL & APPEALS

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

In other words, because our systems and software are officially recognized CMS, not only do we help you meet CMS requirements by getting it right the first time, we also help you substantially reduce the hassle, time, and expense that you are now spending on denials and appeals. We have a proven track record of over 3,400 wins before the ALJ (Administrative Law Judge). We are here to do the same for you.

DENIALS

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 and is deemed inappropriately paid. It's frustrating enough to get denied payment for the good work you do, but are you prepared to return the money you've already been paid?

We can help. Backed by 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.

 

APPEALS

We have won over 3,400 appeals before the ALJ and have repeated success in helping to recover multi-millions of dollars for hospitals, providers, and healthcare facilities.  The reason for our repeated success is our proven, all-inclusive approach.  Our team of highly knowledgable subject matter experts relentlessly stay on top of the ever-changing rules and skillfully sight current regulations, laws, clinical indications, and CMS guidelines. This gives you the innovative edge to reverse denials and get paid for the hard work you do.

 

Your Success is Our Priority

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The Tidal Wave of Change in Healthcare Today — Why Hospitals and Providers are Struggling to Stay Afloat

 

"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 25 years of experience in healthcare and its related research, sheds light and sees hope in this publication. Mark not only provides a masterful analysis of why hospitals and providers are struggling to stay afloat, 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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