Every Provider Must Fight for Medically Appropriate Care

Wickline v. State has been a pivotal case in healthcare law, reinforcing that healthcare providers have the legal right and requirement to challenge improper medical necessity denials. At ERN, we align our services with this landmark case and other regulatory standards to ensure that healthcare providers can assert their legal rights, defend claims effectively, and stay compliant with industry regulations.

$39B

is spent annually on regulatory compliance across nine domains.

Protect Your Practice with ERN’s Compliance Expertise

ERN’s Regulatory Compliance & Risk Management services empower providers to stay compliant with evolving healthcare laws and avoid costly fines. Our experienced team works closely with your organization to assess regulatory risks, implement best practices, and prepare your team for audits. With ERN’s expertise, you can confidently navigate regulatory requirements and focus on patient care while we handle the compliance complexities.

Non-compliance Penalties:

Failure to adhere to regulations can result in severe financial penalties, including fines and legal actions. Many healthcare organizations, especially those who don’t stay current with new laws, find themselves hit with unexpected fines that could have been avoided with the right compliance processes in place.

Risk of Audit:

With an increasing number of audits targeting healthcare providers, non-compliant practices are at heightened risk. If your organization has gaps in its compliance framework, you could be exposed to detailed scrutiny from regulatory bodies, potentially leading to reimbursement denials, reputational damage, and the allocation of resources to defend your practices.

Changing Regulations:

Healthcare laws and payer-specific rules are constantly evolving, leaving practices vulnerable to missteps. Without the ability to adapt quickly to changes, you might inadvertently violate regulations, which could disrupt patient care or result in penalties, potentially affecting your revenue stream and operational workflow.

Reimbursement Delays:

Compliance violations are a primary cause of claim denials and delayed reimbursements. A single missed regulatory requirement or an overlooked compliance gap can lead to payment delays from payers, disrupting your practice’s cash flow and undermining the financial health of your organization.

Operational Inefficiencies:

Without an effective compliance program, healthcare organizations often face administrative bottlenecks. These inefficiencies can pile up, leading to delays in patient care and potential legal disputes, as well as hindering the productivity of staff who are caught up in manual compliance tracking rather than focusing on patient care.

Wickline v. State: A Key to Your Compliance Strategy

Our regulatory compliance and risk management services ensure that your organization is protected from improper denials and remains compliant with ever-changing regulations. We integrate legal precedents like Wickline v. State to ensure that your claims are handled with the full knowledge and expertise they deserve.

RevAssurance

TRAF Representation

NCRA Certified Training

ClaimCure Consulting

Connect with a Compliance Expert today

Learn more about how ERN’s Regulatory Compliance & Risk Management services can benefit your practice. Get in touch with us for a consultation and explore how we can help mitigate your compliance risks today.