We start right off with actual requests from four organizations missing almost $11 million in compliance mandated services, where medical necessity was found and they failed to act. Over the entire practice this is 4-5X the Medicare number, so $45-$50 million.
These organizations are being penalized for not taking this revenue. How? On one sample code a compliant provider receives $352, and a noncompliant provider receives $179. There are 42 contract amounts within that range.
Since 2007 we have helped to architect and build this value-based grading systems for, with, and in collaboration with CMS/Payers. This makes us uniquely qualified to turn these penalties into rewards for you.