Our Results

Overview

 A care management program was identified as operating outside of CMS compliance requirements. Deficiencies spanned patient consent practices, eligibility verification, referral and prior authorization workflows, clinical documentation standards, and claims submission integrity. The result was a high-volume program generating significant claim denials and net revenue loss despite carrying a large enrolled population. A structured remediation engagement was initiated to bring the program into full compliance while preserving sustainable revenue. 

 The Net Effect: a program that appeared robust on paper but was generating significant lost revenue through denials, recoupment risk, and administrative rework — while also exposing the organization to audit liability.

MyVitaLink Stepped in to help!

• Performed a full audit of all care management programs

• MyVitaLink deployed its proprietary platforms, trained staff, and standardized policies across every deficient area identified and brought programs into full compliance

• In the end, with compliance infrastructure in place, new enrollment shifted to a focused, criteria-driven model. Clean claims moved through payers with minimal friction. Revenue per patient increased materially, and staff time previously consumed by denial management was redirected to patient care and targeted outreach