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The RN-Coder Network provides litigation support in matters involving coding, billing and reimbursement of medical claims. RN-Coder professionals are experienced in interpretation and application of Federal, State, and private payer guidelines as well as assessment and evaluation of provider-payer issues, including allegations of inaccurate coding of claims, fraudulent claims submission and improper billing practices. The RN-Coder Network provides expert testimony in cases involving Federal and private third party payers. Our team includes Registered Nurses trained and certified as RN-Coders, RN-Auditors and Certified Medical Coders and other specialists in medical documentation review, Medicare and third-party reimbursement, quality improvement and utilization review.
Review of Recent CasesCase 1
A group of hospitals filed suit to recoup alleged underpayments. and improperly reviewed claims. The RN-Coder Network was retained to ascertain whether the hospital's allegations had merit. The RN-Coder Network professionals reviewed a large number of hospital admissions to determine validity of ICD-9-CM coding and inpatient payments. RN-CODERS personnel performed an extensive line-item review of each case, completing detailed individual case abstracts. A comprehensive summary of findings was submitted with a written analysis. In addition, one-day stays were reviewed to determine appropriateness of admission based upon InterQual. criteria.
Case 2
A group of emergency physicians filed an arbitration suit against a nationally recognized payer, alleging inappropriate denial of payments. The case was critical because of its "test case" status and implications for physicians and payers statewide. The RN-Coder Network professionals reviewed contract materials, provider manuals, and legal briefs associated with the case. Expert witness testimony was provided by RN-Coders regarding protocols for accurate coding and billing of specific emergency physician services.
Case 3
A large hospital system filed suit against a national HMO alleging underpayments for Neonatal Intensive Care Unit and Cardiac Care Unit cases. The RN-Coder Network personnel reviewed claims data, the chargemasters, provider manuals, plaintiff expert witness reports, and contracts associated with the case. Research and expert witness testimony was provided by RN-CODERS personnel regarding appropriate revenue code usage for Neonatal Intensive Care Unit claims submission and levels of care for NICU and CCU patients.
