An exclusion from CMS can cripple the most established of medical practices and derail medical careers.  A CMS exclusion starts the domino effect of decredentialing actions by private insurers that leaves a physician and practice subsisting only on self-pay patients. 

Apex has experience fighting CMS exclusions, revocation of billing privileges, decredentialing matters and debarments.  Call on Apex to help you defend against the relentless attacks from private insurers and state and federal agencies.

Credentialing disputes, unfortunately, are not the only issues physicians frequently face that can impact their ability to earn a living.   Hospital disciplinary actions can effect a physician’s license and credentialing with CMS and private insurers. 

Apex can assist you in defending hospital credentialing matters and restriction of privileges.  Don’t let a negative hospital action reflect poorly on your reputation and put your license and career at risk.

Physicians are no strangers to litigation.  Apex’s extensive knowledge of the healthcare system and litigation gives us a unique insight into not only the defensibility of a matter but also the impact of a settlement, such as the reporting of same to the National Practitioner Data Bank and the State Medical Board.  Let Apex serve as a consultant to oversee your insurance appointed attorney’s defense of the matter to ensure your interests are being protected.  Apex can educate you as to what you can expect from settling a lawsuit so that you can avoid making a rash decision that could impact your practice and license.

Historically, the most prevalent cases against physicians have come from patients in the form of medical malpractice claims.  Now, healthcare professionals are facing increased scrutiny and litigation from state and federal agencies, as well as private insurers.  Federal agencies are targeting physicians as the new war on drugs shifts to physicians across the country.  Meanwhile, the CMS is actively seeking to recover billions of dollars it believes was inappropriately paid to physicians. 

Whether you face a civil false claims act suit, a criminal suit for fraud, waste and abuse or a lawsuit alleging indiscriminate prescribing, Apex stands ready to help your counsel avoid a misstep that could cost you your license or credentialing. 

Consulting Services

Social Media & Online Reviews

Apex is your one-stop shop to answer all of your healthcare needs.  Whether you are looking to expand your practice by venturing into the world of telemedicine or simply looking to renegotiate contracts with vendors or provider agreements with insurers, let our expertise guide you.

Apex offers a variety of practice solutions that are cost conscious.  We offer the services of experts in the field of healthcare at prices even solo practitioners can afford. Our consulting agreements range from simple a la carte services, such as responding to an audit, to our comprehensive General Consulting Agreement wherein Apex is at your disposal year-round for all of your practice needs.

If your practice is in need of polices, practices and procedures to run more smoothly and efficiently, contact Apex to provide you with the vital manuals and policies every practice must have to survive.

Apex's consulting services are the preventative medicine that your practice needs.  You cannot afford to practice one more day with a deficient EMR system that exposes you to audits, non-HIPAA compliant office policies, contracts with laboratories that violate Stark or the Anti-Kickback Statute or a number of other landmines you may not be aware of.  Let Apex protect your practice.

Credentialing, Exclusions & Hospital Privileges

Apex will coordinate a thorough review your documentation, coding and billing practices to determine and lower your audit risk.  Our goal is to ensure your practice is coding properly, documenting adequately to support your most frequently used codes and avoiding the many mistakes that are inherent to the use of electronic medical records. 

Apex will help you ensure your coding is not setting you up for audits.  Apex can help you avoid being an outlier, which puts you at a high risk of both pre and post payment audits.

Is your practice ready for HIPAA audits?  Is your EMR safe from the onslaught of hacking attacks?  Let Apex coordinate a detailed assessment of your practice to ensure it is HIPAA and HITECH compliant.  Let us help you protect not only your patients' privacy but your practice's reputation.

Apex's unique practice risk assessment programs can also give you peace of mind that your practice's agreements with laboratories, other physicians and vendors are compliant with the Anti-Kickback, Stark and state self-referral laws. 

State Licensing Boards, like the New Jersey State Board of Medical Examiners ("SBME") and New York's Office of Professional Medical Conduct ("OPMC"), are charged with ensuring the safety of the public.  State legislators have delegated licensing boards plenary power over the licensing and discipline of healthcare practitioners.

All healthcare professionals, regardless of their field, have a duty to cooperate with their licensing board. Failure to respond to a board request or responding in a cursory manner can have a devastating impact on a healthcare professionals license.

Apex has extensive experience with various licensing boards in New York, New Jersey and Pennsylvania. We have assisted physicians and practices respond to numerous State Board patient complaints, subpoenas and inquiries. We also have extensive experience preparing physicians for, and representing them at, Board sub-committee hearings, summary suspension hearings and interviews.

Apex stands ready to help you defend your license before all Board inquiries and actions.     

Litigation Support

State Board Matters

Practices, particularly small ones, can feel more like a family than a business.  Unfortunately, many physicians fail to treat their practices as a business and are left unprotected against a hostile employee. 

Apex can help practices of all sizes evaluate manage their internal risks and assess the practice's exposure to litigation from disgruntled employees​. 

Small practices are subject to whistleblower complaints just like hospitals and ACOs.  What practices, polices and procedures do you have in place at your practice to deal with disgruntled employees?  What protections are in place at your practice to prevent a disgruntled employee from becoming a whistleblower?

Whether your practice is in need of preventative medicine or help responding to an employee complaint, Apex has the experience to deal with these sensitive issues.  Let Apex help you avoid employment litigation that puts your practice at risk, your reputation on the line and makes you responsible for your former employee's legal fees.

Social Media, when done correctly, can be an advantage to a medical practice.  From reaching new potential patients to networking with other healthcare professionals, social media allows physicians and practices to communicate quickly and in a variety of ways.  But before venturing into the world of social media, every practice needs to have the right policies, procedures and safeguards in place to minimize exposure and prevent harm to the practice.  Apex can guide you through the many pitfalls of social media.

Similar to social media, online review sites have revolutionized healthcare.  It takes years to earn a good reputation and build trust in the community.  Unfortunately, one bad review can damage a physician and/or practice’s hard earned reputation and shatter the trust of patients and prospective patients alike.  Apex understands the importance of responding quickly and effectively to negative reviews.  Contact Apex to discuss the different strategies available to you to respond to negative, malicious and/or defamatory reviews that are harming your reputation and impacting your bottom-line.

Employment Disputes

Audit Defense

Audits are the preferred tool of the CMS and private insurers alike.  Audits come in all shapes and sizes and each requires a unique approach. 

Pre-payment audits can shut off reimbursements to a practice for months.  Apex can help you get off pre-payment review quickly to end the disruption to your practice's cash flow.

Meanwhile post payment audits demand the repayment of monies already paid to a practice, which can be in the six to seven figures.  Apex has the experience to ensure the overpayment demand is accurate, the auditor's findings correct and the look back period accurate. 

Apex's healthcare experts are also extensively experience responding to Medicaid Fraud Audits, RAC Audits, HIPAA Audits and Meaningful Use Audits.

Apex's approach to audits is proactive, not reactive.  We demand accountability and transparency from the auditing institution and advocate on your behalf.  Apex has your practice's best interests in mind and will always work to resolve the audit quickly and cost-effectively.   ​

Risk Assessment