AddVal's "ADDING VALUE" Case Study: #2
AddVal, Inc. | Unrivaled Medical Credentialing Expertise!

AddVal Helps Physician Practice Awake from Year-long Nightmare

The Challenge


Ronald J. Policastro, MD, Inc., a gastroenterology practice located in Fountain Valley, CA, has been in practice for 32 years and his wife Cindi manages the practice. A simple move of six miles from Huntington Beach, CA to Fountain Valley, CA precipitated a year-long nightmare that still lingers in their minds.

Soon after the move was completed, Cindi filed, what she considered to be, the proper paperwork with Medicare for registering the change in the location of a medical practice. She even received a phone call from Medicare saying everything was fine. A few weeks passed and Cindi received a phone call from her billing company saying that the practice's NPI was not valid and Medicare was rejecting all of their claims.

It was at this point that the nightmare enveloped the Policastros. Cindi began getting up at 5:00 a.m. Pacific Time, so she could do her daily phone battle with Medicare. She submitted multiple new forms, each completed in differing ways to try and comply with the additional requests from Medicare. According to Cindi, "Every submission had some minor details that needed to be corrected and resubmitted."

Weeks and then months passed with Medicare continually denying their claims for payment. The practice's bank account approached a zero balance. Cindi was forced to go to their bank and borrow money to cover operating expenses. The scenario of completing and filing new Medicare forms and receiving rejections went on for almost a year, until the practice was over $40,000 in debt. "One of the saddest things was that we had to turn away our loyal Medicare patients," Cindi commented.

At this low point, Dr. Policastro turned to the Internet for a solution and found AddVal. He came home one evening and told Cindi he thought he had found someone who could help them.

The Solution

Cindi called Michelle McFarlane, CEO of AddVal, and told her about their practice's plight with Medicare & the dire straits of the practice. Cindi gave Michelle the information needed for Medicare. As soon as Cindi provided the information to AddVal, the correct forms were completed and returned for Dr. Policastro's review & signatures. Everything was completed & submitted to Medicare within a week. "Michelle made everything so easy; she sent me the completed forms and all we had to do was sign in the appropriate places," Cindi commented.

The Results

Less than 60 days after AddVal filed the first Medicare forms, Dr. Policastro received a check for $18,000 from Medicare – his first reimbursement in over a year. From then on, Dr. Policastro has continued to receive the Medicare reimbursements to which his practice is entitled. However, the practice is still struggling to recoup the revenue lost during its year-long credentialing battle with Medicare.

"I don't want to sound dramatic, but Michelle and AddVal saved my life and our practice," Cindi said. "I have never worked with a more caring group; they had empathy for the situation my husband and I were in and they were able to help us come back from the brink of disaster. Contacting AddVal was the best decision our practice has ever made, bar none," Cindi concluded.

Don't Tackle Medicare on Your Own

Without exception, Medicare credentialing is the most difficult to achieve. Just when you think you know what needs to be done, the rules change and you have to start all over again. With a substantial amount of physician reimbursements coming from Medicare, it is imperative to understand how their system works.

PECOS Is Not a Panacea

Although the CMS Internet-based Provider Enrollment, Chain and Ownership System (PECOS), an alternative to the paper (CMS-855) enrollment process, was supposed to simplify matters, many providers are finding the system very difficult to navigate. The new system has several nuances that if not handled properly can interrupt a physician's cash flow from Medicare. Some physicians who have attempted to comply with PECOS on their own have reported that it was a "very difficult and constrained system."

Medicare provides a source of assistance for both PECOS and completing the 855 forms. However, each time you call, you may receive conflicting directions. Once the specialist begins work on your application, it is crucial that you respond to the requests immediately. If you have supplied an email address, check for emails from Medicare regularly. One practice's Medicare payments were stopped because of failure to respond to an email request.

Let Us Help

As with any complicated credentialing process, it may be wise to call on an experienced resource who has helped multiple physicians enroll in the paper-based and PECOS systems to insure there is no disruption in your Medicare cash flow.

Even after an individual has a basic knowledge of all the various types of Medicare credentialing, understanding how to apply this knowledge to achieve an accurate and successful credentialing process is very difficult. Navigating the many twists and turns presented by Medicare requires help from someone who has been down that road many times before. An experienced guide will save you time, money and untold headaches, while insuring you will get paid for rendering the quality care you provided.

About Add Val, Inc.

AddVal, Inc., based in Southampton, PA, currently serves over 5,000 clients across the U.S., providing experienced medical credentialing services. The company employs a unique blend of talented individuals experienced in clinical administration, healthcare insurance and medical credentialing. This team, combined with a singular focus on credentialing, produces unrivaled results for clients.

AddVal, Inc

Unrivaled Medical Credentialing Expertise
AddVal, Inc.
1018 Street Rd, Suite 102
Southampton, PA 18966

Telephone: 215-396-8972    |    Fax: 215-364-2187    |    Email: mmcfarla@addvalinc.com
 
See Previous Case Study: #1