3 0
O U T P AT I E N T S U R G E R Y M A G A Z I N E O N L I N E | O C T O B E R 2 0 1 5
potential of successful litigation with an attorney.
• Recoupment letters. Always call an attorney if you receive a notice of
recoupment from a payer. You should first investigate these with the
assistance of an attorney experienced in medical billing disputes.
• Fraud investigation/special investigations unit. Sometimes, an insurer will
"flag" a provider for fraud or will refer the provider to a "special inves-
tigations unit." These flags will delay payment, if not stop it altogether,
since you are required to submit certain documentation prior to pay-
ment on any claim. An attorney can assist you with resolving whatev-
er issues caused the "fraud flag." Getting out of this pre-payment
review, or the fraud unit, is critical to maintaining your revenue
stream. OSM
C O D I N G & B I L L I N G
Ms. Lemoine (elizabeth.lemoine@wickphillips.com) is a partner at Wick Phillips Gould & Martin in
Dallas, Texas. She counsels healthcare providers on all aspects of their work environment, including compli-
ance issues, billing disputes and employment agreements.
