Washington & West, LLC
We are a full service denial and appeals management company serving the health care industry. We are dedicated to assisting hospitals and healthcare systems throughout the entire denial and appeals process to ensure that they are adequately reimbursed for the services they provide. What sets us apart from our competitors is our unmatched recovery process which is managed by our proprietary software, Quantum Appeals.
The challenges posed by working large volumes of time-sensitive, complex denials, many with combined administrative, legal and medical issues, mandate the use of a robust software tool. However, in 2002 the software available merely created work lists of denials, and did not supply the means to work those denials to a successful conclusion; nor did the available software supply meaningful reporting.
Accordingly, Washington &West decided to develop software which would have combined medical, legal, and business office expertise embedded into the program. This program would enable users to access W&W’s proven best practice methodology for overturning denied RAC/Medicare and other health insurance claims. Finally, this program would have detailed reporting capability for hospital executives with meaningful data that would ultimately aid in denial prevention.
In 2006, Quantum Appeals went live and currently supports 244 hospitals, including 17 health systems, that have outsourced either all or a portion of their denial management processes to Washington &West.
Each claim we manage is subject to a labor-intensive, team oriented review process. Our interdisciplinary team is comprised of clinicians, attorneys, certified coders, reimbursement analysts and recovery specialists. Utilizing Quantum Appeals to manage the recovery process allows our team to work collaboratively to develop innovative strategies to recover funds from Commercial, Government and Medicare Advantage payers who have wrongfully denied, underpaid, threatened to retract or have retracted payments from providers. Managing the denial appeal process through Quantum Appeals also allows us to provide details, meaningful reports that assist our clients with every aspect of denial management, including denial prevention.
Our services are designed to supplement internal recovery efforts and act as an additional tool in denial recovery. There is no minimum number of cases that our clients are required to refer. Clients can refer the occasional troublesome case, refer cases to us on a regular basis as part of a normal routine or clients can have us process all of their denials on an outsourced basis. Somewhere in this continuum is the ideal solution for your hospital. Our expertise and personal touch ensures that Washington & West is the best choice for hospitals and healthcare systems who are looking for additional revenue opportunities.
Company Development & History
Washington & West was founded in 2002 by attorneys and nationally-recognized denial and appeals management experts Linda Fotheringill and Tracy Wade. Ms. Fotheringill and Ms. Wade are the sole owners of Washington & West, LLC and Quantum Appeals© (a Denial Management software platform that is a product of Washington & West). Together their backgrounds represent over sixty years of experience in the healthcare industry. Ms. Fotheringill began her career in healthcare in 1974 as a Physician’s Assistant at The Johns Hopkins Hospital. Ms. Wade’s career in healthcare began in 1987, as a Patient Registrar at UCLA Emergency Medicine Center.
From its founding, Washington & West has been devoted exclusively to assisting hospitals with revenue recovery for wrongfully denied & underpaid claims. Understanding the complexity involved in managing highly detailed denials, the founders staffed Washington & West with an interdisciplinary team comprised of attorneys, physicians, registered nurses, certified coders and recovery specialists. They developed a process that leveraged the multidisciplinary expertise of the team and worked with leading technologists to build a proprietary software to manage that process.