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Physician Practices
Case Studies
A Mid-Sized Anesthesia Group
The History: A mid-sized anesthesia group with several part-time pain management physicians experienced a financial crisis after Medicare audited numerous E&M records and determined that the physicians were upcoding for the majority of services. As a result, the practiced needed to come up with a $55,000 refund. MiraMed began working with the group in an effort to capitalize on the financial potential inherent in pain management, while limiting exposure to risk areas.
The Solution: MiraMed provided the practice with the necessary commitment to compliance through its formal compliance program, which includes the following:
- An internal compliance department lead by a full-time compliance officer and assisted by auditing and monitoring staff members
- A compliance library that includes continually updated payer manuals for each state as well as other pertinent resource materials
- A distribution system that enables MiraMed to maintain necessary coordination and communication with clients
- A series of internal policies and procedures designed to increase compliance and optimize efficiency
- An auditing and monitoring department that proactively ensures internal and client compliance
- A comprehensive compliance education program
- A chronic pain management expert and compliance liaison who works with codes, account managers and clients
- An internal reporting system which helps to identify potential compliance issues
The Benefit: The practice can now concentrate more fully on the delivery of high quality services with the assurance that its billing company has taken care of all compliance issues.
