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What Services are Offered by Washington & West?
We provide revenue recovery services designed to supplement internal recovery efforts. However, for those who are not able to work these claims, we offer a complete denials management outsourcing solution. Some of our clients have utilized our consulting services to further enhance their denial management program.
What Sets You Apart from the Competition?
Our staff. In order to provide the industry's most effective service to clients, our staff consists of attorneys, physicians, physician assistants, registered nurses, and business office recovery specialists. Our founders are attorneys with extensive clinical and patient access expertise.
How Successful is the Company?
Our extensive medical claim recovery background and rates of success are among the best in the hospital and healthcare provider sector. Our recovery rates have ranged from 53% to over 90% on denials our clients had deemed otherwise non-recoverable and elected not to pursue.
Can I Expect this Level of Success?
Yes. The degree of success typically correlates directly to the type and timeliness of the referral, as well as their willingness to pursue all available remedies contained in their managed care agreements and as stated by regulatory, statutory, and legal authority.
What Type of Cases Can I Refer?
Given our capabilities and our operating philosophy, we accept referral of any case that has been denied by a third party payor. Since we are not a collection agency, we do not accept any cases in which the hospital's bill is to be paid by the patient or guarantor. We thrive on the challenge of a varied inventory and accept: all payors, all care locations, and all denial types.
How Many Cases Do I Have to Refer?
Because we understand how your work gets done, there is no minimum number of cases that you are required to send us. You can choose to send us the occasional troublesome case. OR You can refer cases to us on regular basis as part of a normal routine. OR You can have us process all of you denials on an outsourced basis. Somewhere in this continuum is the ideal solution for you!
How Long Are We Obligated to Work with You?
As long as you like. Since we believe that our success will speak for itself, we use a nonbinding, nonexclusive 'Teaming Agreement' to describe the relationship between the client and Washington & West. If your situation changes or you are no longer interested in our services, you can just stop referring cases to us. However, we believe that our success and service will result in a longstanding relationship that you will be pleased to continue.
Do You Provide Regular Status Reports?
Effective communication is one of the keys to a successful relationship. Our internal system is designed to track detailed data that enables us to identify trends and provide feedback to the client for risk management and process improvement purposes. A monthly status report is generated on all claims that have been referred to us. Perhaps as important to the client is a periodic risk management report that identifies trends in payor denial practices.
What are the Fees for Your Service?
Washington & West, LLC establishes fees for handling denied claims on a contingency basis. Unless we recover on a claim, we receive no fee for our work. In many respects, then, working with us is 'risk free.'
Is Washington & West, LLC a Law Firm?
Washington & West, LLC is not a law firm and does not practice law. Therefore, if legal action is required to successfully resolve a claim, we will, upon our client's request, refer the claim to outside legal counsel chosen by our client. Washington & West, LLC often works in conjunction with Fotheringill & Wade, LLC, a law firm whose practice is focused on the representation of clients in health insurance revenue recovery.
How do I Refer Cases to You?
In order for us to successfully appeal denials of payment, we need to have access to the basic documents used in processing and working a claim in the hospital. At a minimum, we need the UB-92 or CMS-1500, internal computer notes from the Patient Accounting system, and an executed authorization & release to work on your behalf. While this has been largely a paper process, more of our clients are making this information available in an automated fashion. The use of technology speeds up the entire process while reducing the human resource commitment for our clients.
Do You Ever Need More Information?
After a thorough analysis and development of a strategy to pursue the claim, Washington & West, LLC may request additional information based on specific circumstances of the case, including but not limited to: patient medical records, payor contract(s), payor's correspondence regarding denial of claim, itemized bill, copies of insurance authorizations & verification, and correspondence between client & payor.
What about Privacy?
Recently, a Privacy Rule was enacted by the Center for Medicare and Medicaid Services (CMS). Under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), CMS was required to adopt rules protecting patient privacy, both in the setting of care and by subsequent users of protected health information. In keeping with the tenets of the Privacy Rule, Washington & West, LLC has established HIPAA compliant policies and practices to ensure patient privacy. In addition, we routinely establish a Business Associate Agreement with each client that spells out our obligations under HIPAA.
How Can I Get Additional Information?
We enjoy talking about our work almost as much as we like getting denials overturned! Please give us a call at (800) 704-5574 or send an e-mail to info@washingtonwest.com. It would be our pleasure to call or send you additional materials.
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