A · Immediate repayment
Repay now
Pay the principal immediately; avoid future estimated interest.
- ↳ Certain payment · 100%
- Total cost $100,000.00
Amount paid now
$100,000.00
Build your outcomes evidence with Arclight Analysis.
Services
Arclight Audit & Appeals
Post-payment audit response and Medicare appeal support for wound-care providers facing overpayments, recoupments, contractor reviews, and ALJ-stage disputes.
Medicare appeal decision tool
What could you save by appealing?
Compare paying an overpayment demand now with appealing. Explore estimated interest, service fees, and potential savings using your own assumptions, then request a free review.
A post-payment Medicare audit can place months or years of wound care, multiple patients, and substantial reimbursement at risk. The defense must make a large and often fragmented clinical record understandable claim by claim.
Arclight combines wound-care operating experience, documentation analysis, Medicare policy, denial-rationale review, evidence mapping, appeal writing, and hearing preparation to build a coherent record from the audit response through the ALJ stage.
The result is a disciplined, adjudicator-ready presentation: patient timelines, wound-level evidence, issue maps, policy responses, exhibit packets, and hearing strategy built around the facts that decide the case.
Wound-care documentation services
Wound-Care EMR Templates & Documentation Optimization
Address stale carryover, contradictions, and unsupported findings with template work led by an advanced practice provider: a clinical nurse specialist with years of experience in wound care. EMR vendor coordination, training, and post-implementation chart checks support corrective action.
Audience
- Wound-care providers
- Mobile providers
- Physician groups
- Advanced practice providers
- Suppliers
- Healthcare organizations
Post-payment audit and appeal support
- UPIC, MAC, SMRC, RAC, and TPE post-payment reviews
- Overpayment determinations and recoupment
- Skin substitute and wound-care claim audits
- Documentation and medical necessity denials
- Redetermination and QIC reconsideration
- ALJ appeals, hearing preparation, and representation
Looking for product access and prepayment support?
Arclight Access offers Product Only, Prepayment Reimbursement Support Only, and a Complete Program that combines separately priced product and support components.
Medicare Audit Appeal Decision Calculator
What could fighting the demand be worth to you? Enter the amount due, an appeal fee or quote you have received, and your assumed chance of full relief. Compare potential savings after fees with repaying now or another appeal option.
This is not an Arclight Action quote. These scenario estimates help you explore the economics; they do not assess your case or predict an individual judge's decision.
Build your scenario
$1–$100 million. Commas and cents are accepted.
Annual percentage; 10% is a planning assumption.
Planning timeline estimate; not a minimum or guaranteed timeline.
Assumed probability of full relief by the end of the appeal through ALJ, based on documentation and quality of your representation.
Mixed scenario; meaningful evidence with substantial uncertainty.
These are hypothetical scenario descriptions, not validated probability estimates. Buying junior, experienced, or specialized support does not establish a success rate.
For a more custom estimate, please reach out to info@arclightaction.com.
Enter the total fixed fee for all appeal levels through ALJ, including redetermination, Qualified Independent Contractor (QIC) reconsideration, and Administrative Law Judge (ALJ) representation. The fee is paid whether the appeal wins or loses. This is not an Arclight quote. Use fees or quotes you’ve received elsewhere to see the value to you.
A second appeal service, separate from repaying now. Both appeals use the same interest rate and resolution period.
What could you save by appealing?
- Demand principal
- $100,000.00
- Estimated simple interest
- $6,666.67
- Projected balance at resolution
- $106,666.67
Your estimated savings
$39,166.67
After your appeal fee, compared with paying the demand now. The estimate accounts for both winning and losing using the chance of winning you selected.
Under these assumptions, appealing comes out ahead on average.
How much could you pay and still come out ahead?
- Your appeal fee
- $7,500.00
- Break-even fee
- $46,666.67
This is not an Arclight Action quote.
At the break-even fee, your estimated savings are $0. Pay less and the difference stays with you; pay more and, under these assumptions, it makes more financial sense to repay the demand. This is a scenario calculation, not a quote or a market price.
Bring the scenario to a free review
Documentation, the appeal stage, and the specific issues matter. Request a free review to discuss your situation.
No contact details are needed to use this calculator. Sharing the scenario is optional.
Three paths. Different financial outcomes.
Start with a $100,000.00 demand. The appeal fee is paid whether you win or lose. Each branch shows what that outcome could cost after 8 months.
Win probabilities are assumptions, not predictions. A full loss includes the demand, estimated interest, and appeal fee.
Decision at demand
B · Alternative appeal
Add another appeal service
Enable the comparison to model a second fee and assumed probability. This is a separate appeal option.
C · Appeal option
Proposed appeal service
Appeal service fee
$7,500.00
Fixed fee, paid whether you win or lose
This is not an Arclight Action quote.
- ↳ If you win in full · 50%
- Appeal fee only: $7,500.00
- Demand and estimated interest eliminated.
- ↳ If you lose in full · 50%
- Total payable: $114,166.67
- Demand + estimated interest + appeal fee.
Compare the economics
| Total cost / value | A · Repay now | C · Proposed appeal |
|---|---|---|
| Appeal service fee | $0.00 | $7,500.00 |
| If you win in full | $100,000.00 | $7,500.00 |
| If you lose in full | $100,000.00 | $114,166.67 |
| Estimated savings vs. paying now | $0.00 | $39,166.67 |
Win and loss amounts include the appeal fee. Repaying now has one certain cost. Estimated savings account for both outcomes; actual results may differ.
See the calculation
For this comparison, we combine what you would pay if you win with what you would pay if you lose, using your selected chance of each outcome. The figures below are averages for planning, not appeal fees or bills you would receive.
- Repay now
- $100,000.00
- Proposed appeal: average scenario cost
- $60,833.33
About these estimates
These figures help you compare options using your own assumptions. Your actual costs depend on the outcome of your appeal.
How the estimates are calculated
Estimated simple interest = demand × annual rate × months ÷ 12. The projected balance adds that interest to the demand. Expected appeal cost = fixed fee + probability of full loss × projected balance. Expected savings subtract that cost from the demand paid today.
The fee ceiling versus repaying now is demand − probability of full loss × projected balance. With another appeal service, its fee + probability difference × projected balance gives a second ceiling. The relevant ceiling is the lower of the two, so the proposed fee must leave value against both comparisons.
Assumptions and Limitations
- Full relief eliminates the entire modeled demand and associated interest. Full loss leaves the entire balance payable.
- The service fee is fixed and paid whether the appeal wins or loses.
- No partial relief, intervening repayments, recoupment, additional expenses, later appeals, discounting, or separate financing costs.
- Both appeal services use the same interest rate and time to resolution. Actual cash flows may differ.
- Interest and timeline are editable planning assumptions. They do not establish the applicable Medicare rate, accrual rules, or case timeline.
- Scenario probabilities are hypothetical. This calculator does not determine actual case merits or predict an individual judge’s decision.
- Calculations retain exact decimal values until display. Displayed amounts round to the nearest cent; small rounding differences between displayed components can occur.
Service areas
Wound-Care Documentation Review
Review wound measurements, photographs, debridement history, conservative care, treatment progression, vascular status, offloading, orders, product use, and medical necessity support.
Skin Substitute Audit Strategy
Build patient-specific and product-specific support around wound type, failed conservative care, product identification, graft sizing, orders, photographs, and treatment response.
Denial Rationale Analysis
Map contractor rationales against the record, Medicare policy, claim facts, and available evidence, including rationale drift across appeal stages.
Patient and Claim Evidence
Build patient timelines, wound-level summaries, claim maps, outcomes evidence, issue matrices, and adjudicator-ready exhibits.
Appeal Packet Development
Prepare redetermination, reconsideration, and ALJ submissions with issue-by-issue responses, supporting evidence, and organized exhibits.
ALJ Preparation and Representation
Develop the hearing theory, exhibit index, testimony plan, patient-level defense packets, and concise presentation for the ALJ hearing.
Engagement options
These options describe the scope of support. Request a case review to discuss your needs. Use the calculator above to evaluate a fee or quote you have received and compare what is included through each appeal level.
Audit Triage Review
Review the audit scope, documentation risk, denial theory, missing-record needs, deadlines, and recommended defense strategy.
Appeal Record Buildout
Build patient summaries, issue-by-issue responses, exhibit organization, documentation analysis, policy support, and appeal materials.
Full ALJ Preparation and Representation
Develop the full case strategy, hearing brief, exhibit index, witness preparation, patient-level packets, policy exhibits, and hearing presentation.
Hybrid Counsel Support
Work alongside healthcare counsel so specialized record, clinical, and policy development is handled efficiently while counsel addresses targeted legal issues.
Audit and appeal outputs
- Audit posture and vulnerability assessment
- Patient and wound timelines
- Missing-records list
- Claim-level issue map
- Patient-by-patient appeal packets
- Issue-by-issue contractor response
- Policy and evidence framework
- Outcomes and real-world evidence exhibits
- ALJ hearing strategy and testimony outline
- Documentation improvement recommendations
Audit and appeal process
01
Assess the audit posture
Review the contractor, procedural stage, deadlines, claim universe, and asserted denial rationale.
02
Organize the record
Build the patient, wound, claim, product, and documentation structure needed to analyze the case.
03
Map every issue
Compare each rationale against the record, Medicare policy, claim facts, and available evidence.
04
Build the appeal
Develop the narrative, patient summaries, issue responses, exhibit list, and supporting evidence.
05
Prepare and present
Prepare the provider and record for the next appeal stage and present the case at the ALJ hearing.
Arclight Audit & Appeals
Post-payment audit response and Medicare appeal support for wound-care providers facing overpayments, recoupments, contractor reviews, and ALJ-stage disputes.