Legal disclaimer- Pinnacle legal services uses a wide variety of legal professionals including paralegals, legal secretaries, research associate and individuals with degrees in legal studies.
These employees assist in researching and drafting documents. However all representations in court are through licensed attorneys.
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Pinnacle has represented hundreds of criminal defendants and healthcare companies in their legal challenges. We have successfully participated in criminal appeals in each US District Court of Appeals and have won relief. We have also assisted in the filing of 2255 and 2241. We specialize in healthcare fraud, but assist in other legal matters.
In addition to the criminal aspects of the proceedings Pinnacle performs a full range of investigation services when individuals and companies fall under regulatory scrutiny or they have corporate indictments. These matters need to be taken seriously, and handled within the law, and with great care.
Let Pinnacle handle your prep work. Allow us to do the corporate investigations and improvements you need.
Pinnacle offers a full line of consulting services. Our healthcare practice covers both payers and providers.
HMO's hire Pinnacle to expand their provider network, correct their claims processing cycle, assist in managing their hospital or other clinical billings, develop their strategic plans and benefit packages. We are involved in various types of audits through Medicare and Medicaid. Including expansion county audits, annual audits and accreditation audits. We use statistical analysis to improve financial performance.
Pinnacles Hospital Services include hospital claims and revenue cycle analysis. Patricia Cleary is our expert on claims and has written books on PFS, she is highly sought after for her ability to analyze the revenue cycle and improve it's performance is coveted. Ms Cleary has participated in drafting legislation, and recommending and often defending practices. When there is a question in admissions, registration, chargemaster, billing, or HMO payments Patricia Cleary is our expert.
Pinnacle is looking for candidates who are interim leaders. These individuals can be placed in both hospitals and HMO'S across the country. They will act as temporary leadership until their own candidate can be hired. If you have c-level experience in healthcare and are interested in a temporary placement please forward your resume.
Executive Director of Operations- Our current executive director is taking on new challenges. We are seeking to replace the position. You must have extensive healthcare knowledge. You must have 10 years of hospial and HMO experience. You must have C-level experience in either the hospital or HMO environment. This position is not an either or scenario You MUST have hospital and HMO experience. A strong background in claims, provider networks and compliance. A master's degree in business and the ability to travel 90 percent of the time. If you have this extensive experience we want to hear from you
Attorney- Pinnacle is looking for an attorney with experience in criminal matters and corporate law. A minimum of five years practicing law is required.
" Our hospital is having problems getting paid from a local HMO. When we submit the claim it's denied for no authorization. But the service didn't say it required an auth when we verified coverage. What is wrong?"
One scenario could be that the HMO retroactively enrolled the member. Check with the HMO and see if this is a new member who was reto enrolled.
"I work at an HMO and one of our larger physicians has a service that's in his contract, but the billing can't be adjudicated electronically. What do we do?" (A). It's important for the provider operations manager to develop and cover services which can be processed and paid electronical . This likely makes for cost efficincy and a happy provider. However, there is always an appropriate code for a covered service. Check the contract set up at the HMO and get with the providers coders and billers to ensure you are all placing the codes on the claims in the correct format. Then do a test run with a dummy claim and see if it resolved the problem.
"Medicare has provided a subpoena on a physician practice should we contact the physician and tell him?".
(A) No. That could be viewed as obstruction of Justice. Provide the Justice department with whatever documents are requested on the subpoena, and work with your legal counsel.
"I haven't reconciled our provider enrollment files from Medicare. Is that a problem?
(A). Medicare provider enrollment files are required to be reconciled each month. This is important for the HMO because it ensures you are paid appropriately for each member enrolled.