Risk of Penalties from Non-Compliance with Multi-Payer Regulations

$10,000-$30,000 annually from claim denials, rework costs, and CMS audit penalties on workers comp volume; delayed reimbursement from out-of-sequence billing • $10,000-$40,000 annually in disputed claims, appeals, and lost referral volume from practice dissatisfaction • $10,000-$40,000 annually in disputed payments, refunds, and lost referral volume

Administrator manually reviews payer contracts; uses email to communicate with billing staff about payer-specific rules; relies on payer representatives for clarification; no centralized compliance tracking • Administrator receives audit notice; scrambles to assemble documentation; relies on billing staff to manually pull claims; uses Excel to track audit response; external consultant hired at high cost • Administrator receives audit report; hires compliance consultant; uses Excel to track corrective actions; manual implementation of state requirements; email-based communication with state agency