Experts in Denials Management, Medical Management and Managed Care

Our core business focuses on the resolution and recovery of your denied claims. Whether Inpatient, Outpatient or Emergency Department, our highly specialized team of physicians, nurses and consultants are uniquely qualified to effectively manage your appeals process. For you, this means deciphering the denial reason, delivering a powerful medical necessity argument and navigating bureaucratic and compliance complexities that are typical of payor and regulatory appeals processes. As a result, CMC possesses the know-how to appeal all your denied claims and typically recovers 43% to 62% of your lost earnings.

High Impact - High Touch Management Approach

CMC partners with hospitals and other healthcare providers to manage every facet of the appeals management process, from denial identification through the appeal process until the claim is finally paid. CMC’s proprietary “High Touch – High Impact” process accelerates the denials management process, yielding more than double the recovery dollars typically obtained by other appeals management systems.

Medicare RAC Appeals

Because of our success managing IP, OP and ED appeals CMC is uniquely positioned to support your efforts to safeguard your assets from RAC Audit threats. Our intimate knowledge of CMS National Coverage Determinations and inpatient approval criteria plus our strong reporting capabilities and dedicated team of medical management experts will guarantee for you the maximum possible recovery rate. It is, after all, just another denial.

Value Added REPORTING

CMC automates each denial it receives and enters the data into its proprietary High Touch – High Impact Appeals Management System. This process not only serves the recovery team, but also produces actionable data our clients use to enhance the processes that prevent denials from occurring in the first place.

• Appeals Management Reporting - provides a status of all claims received and disposition through processing.
• Root Cause Management Reporting - provides detailed actionable data on denials by physician, diagnosis and reasons for denials.
• Denials Management Training - based on data uncovered in reporting, training can be provided to minimize the percentage of denied claims moving forward.