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Success Stories

Success Stories

Sucess Story 4

Three-Year Denial Reversed, Claim Paid in Full

Our expertise turned a long-stalled Medicare denial into a successful claim recovery.
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ALJ Orders County to Reopen Application

A Medicaid denial threatened reimbursement but our advocacy secured a full reversal.

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Case Reopened Leading to Medicaid Approval

When Medicaid denial threatened $145K, our advocacy turned the case around.

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Turning a Denial Into $75K in Coverage

A county denial put $75,000 at risk. Discover how our advocacy secured full coverage.

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A Financial Turnaround for Lasting Results

Our financial expertise turned a $100K monthly loss into a sustainable surplus, restoring operational stability.
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Three-Year Denial Reversed, Claim Paid in Full

The Challenge

A facility faced a denied Medicare (MCR) claim for 2022 dates of service under the COVID-19 waiver. The denial was later acknowledged as an error, but the claim remained unpaid, creating an ongoing financial loss for the operator.

Our Advocacy

FCC’s team did not let the case stall. For three years, we persistently followed up with Medicare to ensure the claim was reprocessed correctly. Despite repeated delays, our staff stayed on top of every step until the matter was resolved.

The Outcome

The claim was finally paid in full, reversing the denial and restoring reimbursement owed to the facility. This win demonstrates the value of persistence and expertise in navigating complex Medicare processes.

Why It Matters

By securing payment on a claim that might otherwise have been written off, FCC protected the facility’s bottom line and reinforced our commitment to recovering reimbursement for long-term care operators.

ALJ Orders County to Reopen Application

The Challenge

In April 2024, a Medicaid application was denied, putting the operator at risk of significant financial loss. The County delayed its response for nine months, ignored repeated follow-ups, and continued to demand documentation for an account that belonged to the applicant’s deceased ex-spouse. Even after the bank confirmed no such account existed, the County failed to correct its request.

Our Advocacy

FCC’s team represented the operator before the Administrative Law Judge (ALJ). We demonstrated that the application had been handled in good faith, with timely responses to every request, numerous follow-up communications, and even subpoenas issued to the bank to provide independent confirmation.

The Outcome

The ALJ overturned the denial, ordering the County to reopen the application, issue a new Request for Information (RFI), provide a reasonable timeframe for response, and make a new determination. This decision reversed the financial impact of the initial denial and ensured the operator’s reimbursement was protected.

Why It Matters

This legal win highlights FCC’s commitment to safeguarding the financial health of long-term care operators. By combining Medicaid expertise with persistent advocacy, FCC delivers results that reduce financial risk, strengthen reimbursement, and allow operators to focus on running their organizations with confidence.

Case Reopened Leading to Medicaid Approval

The Challenge

A facility was facing a significant penalty of $45,000 already imposed with another $100,000 pending after the County denied Medicaid (MCD) coverage. The case appeared closed, leaving the operator with substantial financial exposure.

Our Advocacy

FCC’s team stepped in during the hearing process. When the matter was adjourned, we pushed for the County to reconsider and successfully secured agreement to reopen the case.

The Outcome

The case was reopened, the $45,000 penalty was removed, and another $100,000 is pending removal. This decision marked a critical step toward Medicaid approval and preserved vital funding for the facility.

Why It Matters

This legal win highlights FCC’s commitment to protecting long-term care providers. By combining Medicaid expertise with hands-on advocacy, FCC turns potential financial setbacks into recoveries that directly support quality resident care.

Turning a Denial Into $75K in Coverage

The Challenge

A client faced a denial from the County citing “Failure to Provide,” which jeopardized nearly $75,000 in coverage dating back to April 2024. Despite promptly requesting an extension after receiving the RFI late, the County only allowed three days to respond, after a six-month processing delay.

Our Advocacy

FCC stepped in to advocate on behalf of the client. We gathered and submitted the necessary documentation, ensured deadlines were met, and prepared detailed testimony to address the County’s position. Even when two documents were outstanding, we worked quickly to deliver them the very next day.

The Outcome

An Administrative Law Judge (ALJ) issued a Final Agency Decision overturning the denial and securing full coverage for the client. The ruling acknowledged both the County’s delay and the thorough, timely efforts of FCC’s team.

Why It Matters

This win not only recovered $75,000 in coverage but also demonstrates FCC’s unwavering commitment to going above and beyond for our clients. By combining legal expertise with persistent advocacy, we protect critical reimbursement and deliver peace of mind.

A Financial Turnaround for Lasting Results

The Challenge

Facing monthly losses exceeding $100,000, a facility struggled with limited cash flow visibility and delayed financial reporting, hindering timely decision-making and operational stability.

Our Advocacy

We implemented daily cash tracking, custom expense reporting, and ensured timely monthly financial statements, providing leadership with the insights needed to stabilize operations.

The Outcome

Within six months, the facility transitioned from a $100,000 monthly loss to a $30,000 operating surplus, restored vendor confidence, and optimized staffing and purchasing decisions.

Why It Matters

FCC’s intervention delivered financial stability, strengthened vendor relationships, and enabled data-driven decision-making for long-term success.