WCH Service Bureau WCH Service Bureau
  • Services Services
    • Medical Billing
    • Provider Credentialing
    • Medical Auditing
    • Real-Time Eligibility
    • MIPS Support
    • Webinars
    • Practice Analysis
  • Products Products
    • Credentialing Application ©
    • iSmart EHR ©
    • PMBOS ©
    • Time Management Program
  • WCH Franchise
  • Company
    • About
    • Our Offices
    • Careers
  • News
    • WCH Insights
    • Healthcare News
    • WCH News
  • Contact Us
  1. Home
  2. > WchNews
  3. > WCHNewsItem
Phone: 888-924-3973 Technical support Pay Now iSmart Login

WCH Clears Surgeon’s Record, Reinstates Insurances

5/28/2017

WCH Clears Surgeon’s Record, Reinstates Insurances

 

Credentialing Specialist Maria Obodetc joined WCH in December 2016 in the midst of two big cases, and by April, she was celebrating two major victories with her team: reinstating a surgeon with five insurance carriers, and winning an appeal for a new Urgent Care Center.

In April, WCH’s credentialing department helped 18 practices with a variety of specialties get enrolled in several networks, add new certifications and new providers.

“It has been the best education possible,” says Maria, who recently graduated from the University of Exeter in July with a B.S. in business economics.

 

Case #1: Reinstating General Surgeon with Five Carriers and Counting…

 

It began with careless medical records. A general surgeon who had been working with another biller lost his license for six months, proved that charges of gross negligence by the Board for Professional Misconduct were actually a matter of careless medical record keeping, and came to WCH for help getting reinstated.

Timeline:

  • The surgeon lost his license in April 2016, and was terminated from all insurance.
  • He won his appeal with the medical board in October 2016; his license was restored and the gross negligence decision was revoked.
  • The surgeon hired WCH to get reinstated in Medicare, Medicaid and commercial insurances.
  • When Maria joined WCH in December, the process had already begun, the credentialing team had written to insurance panels and they were waiting for replies.
  • Maria called and emailed each insurance regularly for updates.
  • Some insurance carriers asked for additional information; some rejected his appeals due to suspension issues.
  • Maria persistently responded to each carrier’s requests, providing additional information about what happened, how it was resolved, and how his license was reactivated so he could resume seeing patients.
  • One year later, in April 2017, the insurances began reapproving the doctor. First Medicare, followed by Medicaid, the 1199 plan for healthcare workers, Emblem Health, and Multiplan PPO networks.
  • Maria and the credentialing team are now pursuing an IPA for access to additional plans, and will continue to follow up with carriers that have waiting periods or other requirements.

Once Medicare approved the surgeon’s request, others followed. “Medicare and Medicaid were the hardest because of their strict regulations,” says Maria. “It’s important to include Medicare reinstatement in letters to subsequent insurers. If Medicare approved him, they should, too. There is no reason not to.”

The surgeon, who had been calling weekly, was thrilled when the Medicare reinstatement was finalized—a process that took 170 days. He is back to practicing, continuing to work with WCH and he’s referring his colleagues.

 

Case #2: Winning Wellcare Appeal for New Urgent Care Center

 

In May 2016, the Wellcare Medicare Plan told WCH everything was on track to enroll a new urgent care facility. However after six months, Wellcare informed WCH that they were enrolling the urgent care clinic as a primary care provider. That was clearly incorrect.

WCH pointed out the error immediately. When Wellcare said they were now closed for urgent care, WCH fought back and filed a complaint with the Department of Insurance. Maria called repeatedly to check on the status, and in January was informed that Wellcare would make an exception and take the provider into their urgent care panel.

“We are grateful for the Department of Insurance’s influence in this decision,” says Maria. “Because of our persistence and perseverance, we were able to correct an internal Wellcare error, get back on track with what was originally promised and achieve the best possible outcome for our client.”

 

Liked the article? Share with friends:

WCH News

April 26, 2022
Help the people of Ukraine
Shortly after the outbreak of the war in Ukraine, WCH Service Bureau has organized a donation campaign to collect medical supplies and send them to the Ukrainian people. We are astonished by the commi...
April 20, 2022
Outsource your medical billing and improve your cash flow
Insurance claims billing has never been easy. At WCH Service Bureau, we know how hard it is to balance between providing top-quality services to your patients and submitting thousands of claims to ben...
April 12, 2022
WCH joined the International Franchise Professionals Group
We are happy to announce that effective this March, WCH Service Bureau is a member of the  International Franchise Professionals Group.We believe this membership will take us to the next lev...
April 10, 2022
Gratitude to our dear community
Support that saves livesShortly after the outbreak of the war in Ukraine, WCH Service Bureau organized a donation campaign to collect medical supplies and send them to the Ukrainian people. We are ast...

Healthcare News

April 17, 2022
Common challenges of podiatry billing
As it is currently with nearly all medical specialties, getting paid flawlessly is a challenge in podiatry. Newly-introduced podiatry coding guidelines, combined with an increasing number of patients,...
April 12, 2022
Facing insurance audits as an out-of-network provider
Still have no contracts with some insurance payers? While out-of-network payment rates may be attractive, insurances are still quite “peaky” when it comes to quality assurance. However, ha...
April 07, 2022
Billing for split/shared evaluation and management service
If you are a physician working at a private medical facility, you may be cooperating with your colleagues when it comes to determining a patient’s clinical condition and subsequent metho...
April 03, 2022
When to use other clinician's documentation for a more specific diagnosis
Documenting your patients’ clinical conditions is an extremely tough, but important process. The CMS and commercial payers require you to indicate the desired medical necessity in a maximum leve...

Ready to start?

Contact Us
linkedin
⟶ let's start
WCH Service Bureau
Payment options
WCH Service Bureau WCH Service Bureau WCH Service Bureau WCH Service Bureau WCH Service Bureau
Pay Now
Services
  • Medical Billing
  • Provider Credentialing
  • Medical Auditing
  • Real-Time Eligibility
  • MIPS Support
  • Webinars
Products
  • Credentialing Software ©
  • iSmart EHR ©
  • PMBOS ©
  • Time Management Program
Company
  • About
  • Contact Us
  • Careers
News
  • WCH Insights
  • Healthcare News
  • WCH News
Support
  • Feedback
  • Technical Support
  • Privacy Policy
888-924-3973
3047 Avenue U, Brooklyn New York 11229
Fax: 347-371-9968
Follow us:
2022 WCH Service Bureau, Inc.® | Web Design and Programming by WCH Service Bureau, Inc.® | Privacy Notice
Can I help you?
Feruza
Zakhro
Administrative Assistant
Hi, what service does your question relate to?
Medical Billing
Provider Credentialing
Medical Audit
Franchising
PMBOS
iSmartEHR
Eligibility
MIPS Service
Other
What are you interested in and
I will certainly try to help you.
Please, leave your contact details and we will answer your question.
Thank you for your request, we will respond as soon as possible.
Let us Help You

Dear Provider,
WCH can help your practice in your credentialing needs! Using a credentialing specialist with the knowledge, expertise and connections that can help position your practice ahead of time. Let us help you today! During credentialing process WCH becomes your external credentialing department for all communications, submissions, follow up and any other questions that will come up during the process.

WCH Specializes in:

  • All individual Medical specialties
  • Mobile IDTF
  • Single & Multispecialty Groups
  • Urgent Care, Labs, DME, Pharmacy
  • Article 28, 32, 31
  • Revalidation, Reinstatement &
  • Exclusion
We help Providers in All States! WCH provides Clarity, Comfort and Security in your Practice.
Let us Help You
Wch SErvice Bureau

Medical billing services offered by WCH Service Bureau go far beyond the usual understanding of billing.

 

What we offer is not just excellent professional billing and collection services. We also stand as guardians of your reimbursement and compliance with federal, state laws and regulations as well as private insurance policies and procedures.

 

Do it right! Do it with WCH!

Let us Help You
Wch SErvice Bureau

Periodic medical chart auditing is vital for any healthcare provider and medical practice. Let the professionals evaluate your coding, billing, and documentation practices! Our auditors are AAPC-qualified CPMAs (Certified Professional Auditors) and CPCs (Certified Professional Coders). We perform comprehensive Chart Auditing. We can do the following services for you:

  • Identify areas of risk leading to upcoding or downcoding and medical coding accuracy;
  • Ensure that coding practices are compliant with the regulations set forth by private and government payers;
  • Evaluate Incident to guidelines and services performed on collaborative premises;
  • Perform Analysis of Denials/Duplicate billing /Appeal process/Modifier usage;
  • Review Front Desk work including but not limited to: Eligibility verification/Benefit maximums verification/Excluded services verification/Authorization process/Patient responsibility (deductibles, copays, coinsurance)/Coordination of benefits;
  • Evaluate Insurance plans participation and consistency of contracted rates;

Do it right! Do it with WCH!

Try WCH PMBOS
Request information
Perfect! Please fill in the form

What service does your question relate to?

Perfect! Please fill in the form

What service does your question relate to?

Let us Help You
Wch SErvice Bureau

Do it right! Do it with WCH!

REQUEST FREE DEMO
Planned number of Providers : *
Specialty : *
Job Role : *
Perfect! Please fill in the form
Perfect! Please fill in the form
Have any questions? Please contact us practiceanalysis@wchsb.com
Leave us a feedback
 
Thank you
for your feedback!
Wch SErvice Bureau

Thank you for your interest in our company!
Our team will process your request and will respond as soon as possible during regular working hours.

Subcribe
Subcribe Subcribe
 
Our site uses cookie.

This site uses cookies for analytics, personalization and advertising. By continuing to browse it, you agree that we use of cookies. To find out more or change your cookie settings click here.