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Case Study: Biller’s Contract Breach Results in Client Settlement

When a client recently went uncompensated for months of work due to a biller’s breach of contract, we were able to fight on their behalf to recover a $25,000 settlement.

Last spring, one of our clients hired two new pathologists for her team, with a March 1 start date. The client’s biller was informed in January 2021 of the new hires and their corresponding start dates. Initially, our client decided to perform over-reads on all reports until credentialing for the new hires was complete, which the client’s biller told her the process would take about 90 days.

However, well after that timeframe passed, our client was told by her biller that the proper credentialing documents had been submitted and were awaiting response from the payers in question. This is when the Vachette team began assisting our client in the follow-up process to better understand the credentialing delay.

Unfortunately, we found no follow-up had been done with most of the payers, so the payers cancelled the credentialing requests! Because of this, we restarted the credentialing process for several of these payers.

In the meantime, we put together a reasonable proposal of compensation for our client to send to her biller. The proposal highlighted the fact that our client had been performing over-reads for two pathologists for the majority of 2021 and wasn’t going to be compensated by payers due to the credentialing issue created by the biller’s lack of follow up.

After some initial back and forth with the biller followed by a letter from our client’s attorney, the biller agreed to reimburse our client nearly $25,000 for the work she went uncompensated for!

Have a billing issue you’d like to discuss with us, or just looking for ways to improve your overall revenue cycle management? Contact our team today!


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