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Medical Review Preparedness & Response
Efforts to reduce Medicare fraud and abuse have escalated, including expanded auditing of medical records and billing trends by governmental agencies and contractors. The administrative and financial implications of these intensive audits are significant.
Proactive works directly with Providers or through legal counsel using a 3-prong approach to reduce risk and increase favorable audit outcomes.
3 PRONG APPROACH TO REDUCING DENIALS
Risk Assessment – Review of clinical & billing systems focusing on OIG work plan target areas
Training, Auditing & Monitoring – In depth staff training with follow-up monitoring and outcomes of measurement
ADR & Appeals Management- Solutions for improved claims review results
Proactive client claims undergoing Medicare review are more than twice as likely to yield favorable results as non-Proactive clients.
Proactive 97% Claims Success Rate
Non-Client Peers <40% Claim Success Rate
With PT, OT, and SLP experts, in addition to medical billing and nurse consultants, Proactive is uniquely positioned to manage skilled therapy service audits including rehab RUG level payment reviews. The investment in claim compliance yields results.
Services We Provide:
PAYER AUDIT CONSULTING:
MAC, RAC, UPIC, ZIPC, CERT, SMRC AND MANAGED CARE REVIEWS
PART B THERAPY REVIEWS
APPEALS MANAGEMENT WITH CLINICAL REBUTTAL
CLINICAL EXPERT TESTIMONY
STAFF TRAINING & CLINICAL PROGRAMS:
CE APPROVED COURSES
CLINICAL PROGRAM DEVELOPMENT AND MONITORING
MANAGEMENT OF IN-HOUSE THERAPY PROGRAMS
MDS/CLINICAL REIMBURSEMENT SUPPORT
VBP/ ACO SUPPORT
QAPI GUIDANCE AND MONITORING
SELF REPORT CONSULTING
OVERPAYMENT RISK METRICS ANALYSIS
POLICY AND PROCEDURE DEVELOPMENT
REQUIREMENTS OF PARTICIPATION INCLUDING ANNUAL FACILITY ASSESSMENT
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Solutions that empower your team and demonstrate a commitment to compliance.
COMPLICANCE CONSULTING & INTERIM COMPLIANCE OFFICER
CLINICAL DOCUMENTATION & CODING AUDITS
ADR AND APPEALS SERVICES
“Proactive has been instrumental in keeping us informed and compliant with the ever-changing regulations and requirements related to skilled nursing. They have helped us properly document to capture our Rehab RUGs, guided us successfully through the appeal process, and provided exceptional tools and education for our nursing and therapy departments. They work closely in all facets of our daily responsibilities. Thanks to their expertise, we obtained a deficiency-free survey… They have been a great addition to our team.”
Rick Foley, Owner – Parkway Rehab and Nursing Center
“Proactive is very thorough and offers practical solutions…they are on my short-list of consultants I go to when I need consultation on compliance and billing issues for my clients.”
Todd Selby, Attorney – Hall, Render, Killian, Heath & Lyman, P.C.
“Your lecture along with the resources you made available during your presentation are the best tools I have ever been given. Your mentoring will go a long way in my attempt to conduct a quality QAPI program.”
Dave McMahan, Administrator – River Terrace Retirement Community
Let us put our experience in driving quality to work for you! Contact us today to learn more about our services which are reasonably priced by the hour, project, or as part of an annual partnership plan.