LW Consulting, Inc. (LWCI) is a recognized leader in providing compliance, reimbursement, operational, and clinical consulting solutions across the full continuum of healthcare delivery.

We are an Independent Review Organization (IRO), performing audits under Corporate Integrity Agreements (CIA), and an expert resource to providers, attorneys, and government agencies in ensuring organizations meet the myriad of guidelines, requirements, and statutes that regulate the delivery of healthcare services. We also provide interim staffing for post-acute care providers.

Today’s compliance and risk management challenges require innovative solutions.

LWCI has the expertise and experience to achieve them.

Suite of Services

Our team includes compliance professionals, reimbursement experts, RNs, therapists, auditor-coders, and consulting physicians. Many team members possess numerous industry certifications.

Our clients receive peace of mind knowing that they have received reliable advice and guidance that improves their business.

Independent Review Organization (IRO)

We often work with attorneys for providers in negotiating with the MACs, the OIG, federal prosecutors, US Attorneys and State Agencies in evaluating medical necessity, coding and billing procedures, and negotiating the adjudication of potential overpayment, denials, and disputed claims.

LW Consulting, Inc. uniquely blends its comprehensive knowledge of the healthcare industry with a proven ability to work as a partner with healthcare attorneys. We understand the ebb and flow of the legal process. We are flexible, responsive, and complete our work when and where it is needed.

Latest Posts

In 1977, physicians and other practitioners were mandated to be excluded from participation in Medicare and Medicaid by the Medicare-Medicaid Anti-Fraud and Abuse Amendments, Public Law 95-142 if convicted of program-related crimes. In 1981, the Civil Monetary Penalties Law (CMPL), Public 97-35, authorized the Office of Inspector General (OIG) to impose Civil Monetary Penalties (CMPs) and exclusions against persons having submitted false of fraudulent claims to Medicare and Medicaid. In 1996-1997 the OIG’s authority also
The Jimmo Settlement Agreement in January 2013 states that qualification for Medicare coverage depends on the beneficiary’s or patient’s need for skilled care, either nursing or therapy (PT, OT, and SLP) services, and NOT on their potential for improvement. This agreement made the Centers for Medicare and Medicaid Services (CMS) update and clarify the Medicare Benefit Policy Manual (MBPM) Chapter 1 – Inpatient Rehabilitation Facility (IRF), Chapter 7 – Home Health, Chapter 8 – Coverage
Welcome back to our blog series on PDPM! You can find the previous two blogs here:  blog #1 & blog #2. The Patient-Driven Payment Model (PDPM) is the reimbursement methodology for Medicare Part A that has been implemented for Skilled Nursing Facilities (SNFs) since October 1, 2019. The PDPM was designed to improve the accuracy of Medicare reimbursement to SNFs by basing the payment on the patient’s clinical characteristics and care needs rather than on

What Our Clients Are Saying

Gwinnett Christian Terrace

“The manner in which LW Consulting conducted our organization’s board retreat this past January, was both professional and personal. All participants were energized and inspired. As a result, during the board meeting that followed in March, every member was empowered to speak on the issues at hand. For the first time, we had generative discussions that moved the ball forward with action steps assigned to individuals or groups. Absolutely ground-breaking for our organization and we continue to reap the benefits.”

Dana Chandler

Ensign Services

“As we began the process of selecting our IRO, we wanted to engage a company that had an auditing team with real world experience. We wanted accurate and trustworthy results that could add value to our rehabilitation, nursing and MDS programs. We have found that with LW Consulting. The LW team is professional, seasoned, and experienced. The therapists and nurses evaluating our teams and documentation understand the skilled nursing and therapy world. Many of them continue to work as on-call therapists. Their guidance and evaluation skills are founded in the real world of caring for our senior population. Our staff find the LW team to be genuine, knowledgeable, respectable and approachable. Once our IRO relationship ends with LW Consulting, we hope that we will be able to continue to utilize them in a consulting capacity for many years to come.”

Deborah M. Miller RN, JD Chief Compliance & Privacy Officer

Urology Care Alliance

“We have used the services of LW Consulting for the last three years for chart review audits and follow-up training of our 25 physicians. We are extremely pleased with thoroughness and quality of the work that they have done. They have provided both individual feed-back sessions with some of our physicians as well as webinar review and training sessions that all of our physicians attended.”

Alan Plotkin, CEO