

Medical Review Support
Proactive assists providers to prepare for and respond to program integrity audits. Our experts have successfully managed thousands of Medicare ADRs and Appeals, assisting providers to implement effective medical review response systems, to promote substantive charting in defense of skilled services, and to reduce error rates during government contractor investigations and payer audits.
ADR & Appeals Management Services
Proactive Consultants provide complete ADR response and Medicare Appeals management services. Proactive’s extensive medical review experience includes FCA investigation support, as well as successful outcomes with reduced overpayment liability for providers involved in RAC, UPIC/ZPIC, MAC/TPE and commercial payer reviews. Our nurse and therapist experts defend your claims with clinical evidence and regulatory references, and testify on behalf of providers in ALJ hearings.
Audit Services
Proactive’s MDS coding and documentation experts provide the validation and support services you need to ensure accurate reimbursement and supportive documentation that withstands the scrutiny of medical review. Our proven audit program drives coding accuracy to capture the patient-centered care you’re providing to ensure proper payment.
- PDPM Audits: Proactive has completed thousands of detailed PDPM coding and supportive documentation audits since the PDPM payment model onset, and has developed an extensive business intelligence dashboard that trends client data with the option for comparison to peer performance.
- Internal Compliance Audits: Proactive assists providers in conducting internal compliance audits involving potential overpayments
- Remote MCD Case Mix (CMI) Review
- Therapy medical necessity audits by expert PT, OT, and SLP consultants
- Medicare Risk Assessment
MDS Support
Proactive’s AANAC certified MDS nurse consultants offer the support your team needs to achieve your clinical assessment, coding and reimbursement goals. Proactive provides MDS orientation programs, ongoing coding support, and remote MDS coding review for optimal PDPM, CMI and QM accuracy. Annual support work plans are available with a combination of remote and onsite consultation. Learn more about our MDS support services.
Education
Proactive Consultants offer clinical reimbursement training and systems consultation to ensure coding, billing and supportive documentation excellence. Contact us to schedule nursing and therapy skilled documentation training, ICD.10-CM coding training from an AHIMA certified trainer, new MDS orientation, RAC-CT or RAC-CTA workshops with a Master Trainer, or Medicare operational process improvement consulting.
The Proactive team has expertise with audits, new startups, ongoing reviews, setting up systems related to triple check and internal audits, as well as working with us on 5 STAR plans, and reviewing our preparation for ongoing regulatory and compliance changes. We can rely on Proactive to help us with questions, training and audits. We consider them an extra set of eyes that has our backs.
Ask Proactive – What are the most common reasons for the citing of F761 – Storage of Drugs and Biologicals?
Q: What are the most common reasons for the citing of F761 – Storage of Drugs and Biologicals? A: In Appendix PP the regulatory guidance for F761 is as follows: §483.45(g) Labeling of Drugs and Biologicals Drugs and biologicals used in the facility must be...
Documentation To Support Transfer or Discharge for F622 & F623 Compliance
Documentation To Support Transfer or Discharge for F622 & F623 Compliance The decision to transfer or discharge a resident from the nursing facility is not to be taken lightly. Recent updates to Appendix PP of the State Operations Manual are a reminder to...
Fresh Take on Medical Director Oversight in LTC: F841 Compliance & Schizophrenia Diagnosis Standards
Fresh Take on Medical Director Oversight in LTC: F841 Compliance & Schizophrenia Diagnosis Standards Recent updates to the Appendix PP guidance for F841, along with heightened focus on accurate schizophrenia diagnoses, place renewed emphasis on the medical...