CLNC® Success Stories

Certified Legal Nurse Consultant Shares How She Focuses on Medicare Issues*

by Camy Joyner, RN, BSN, CCM, CLNC

As a Certified Legal Nurse Consultant, I focus on helping hospitals reduce Medicare denials and win more Medicare Part A appeals. My photo and short bio on my websites generate four to five calls from hospital attorneys each month.

My photo and short bio on my websites generate four to five calls from hospital attorneys each month.

Hospitals want to be paid and I’ve learned that the first level of preventing Medicare denials is the assessment of the patient and the physician’s documentation of medical necessity. It’s usually the lack of this information that triggers a Medicare denial of payment.

The first rule to get the physicians to buy into what you are trying to teach them is to feed them. So, I contact the hospital administrators in question and explain that I have a plan that will help them reduce Medicare denials and change their doctors’ bad documentation habits. If lunch is not within the facility’s budget, then I work with ancillary vendors who might want to participate and provide lunch.

I use exhibit posters and flip charts to present during lunch (provided by the hospital). I also use a dry-marker board and include actual excerpts from Medicare’s denial documents. The exhibits show what was missing and how to correct it. My program includes hand-outs with the information from the posters, dry board and flip charts.

With Medicare issues, this educational approach usually works and I receive calls from physicians with questions for some time after each event. The marketing benefit is that people from different hospitals talk to one another, which often generates calls from other facilities wanting presentations and I get more clients.

My marketing strategies include:

  • Bulletin board teasers with movie ad-like messages: “For Doctors: Coming soon to your hospital…” posted a couple weeks before the presentation.
  • Hand-outs placed in facility mail boxes at least two weeks ahead of time.
  • Posters on stands just inside the entrance to the presentation room at least 30 minutes before start time.
  • Enlargements focused only on the most important pieces of Medicare rules on the subject that affects physicians.

One of the most rewarding experiences occurred while I was auditing a telephone conference regarding Medicare appeals with corporate attorneys for two of my hospital-clients. One hospital administrator on the call wondered why two facilities seemed to be doing much better than the others in overturning denials. The attorney explained, “That’s because they have a Camy,” as though I were a product brand name.

Another time a different hospital-client armed with the education and hand-outs I provided, was able to make enough immediate and lasting changes that they, effectively, stopped their denials cold. Most hospitals make changes slowly and with a lot of kicking and screaming. This hospital’s collective, firm resolve made the changes using the education they paid me to give them – and won big!

Medicare is my specialty and legal nurse consulting is a perfect match for solving Medicare issues with which hospitals are currently grappling. Although Medicare is my expertise, it’s marketing, as I learned from Vickie Milazzo, that sells my CLNC services.

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*Consulting fees may vary. Results are atypical and may vary from person to person.
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