Denials & Appeals
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Systemic implementation of processes based on extensive review and knowledge of client MCO contracts and federal reimbursement models to yield significant reductions in recoupments and denied claims
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Current 93% success rate on Additional Document Requests (ADRs) and denied claims
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Complete management of the appeals process with quarterly reporting on appeal outcomes and current industry denial trends
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Expertise and on-site guidance on MAC, RAC, UPIC, CERT, and TPE levels of review.
Compliance
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Provide thorough audits of documentation practices, standards and resident processes to mitigate risk of fraud, waste, or abuse and ensure survey readiness.
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Ongoing training for clients regarding regulatory changes at both the state and federal level and implementation of procedures to ensure compliance.
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Monitor professional credentialing requirements of all therapy staff and maintain ongoing licensing demands