Billing and Consulting

Clinical (services arranged with third party)

  • Identify areas of potential deficiencies in the clinical documentation
  • Assist to decrease percentage of prepayment medical review
    • Comprehensive chart review for medical necessity documentation
    • Coding, statutory requirements and professional standards review
    • Referral and treatment criteria for compliance
  • Maximize staff efficiency
  • Payer’s Medical Review Policies
  • Compliance
  • Quality assurance
  • Appeals and hearings at all levels

Reimbursement & Administrative Consultation

  • Initial Certification
    • Complete all the appropriate state, federal & payer’s forms
    • Develop policy & procedure manuals
    • Perform mock survey
    • Assist on Commission on Accreditation of Rehabilitation facilities (CARF), Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and other requirements
  • Practice/profitability analysis
  • Performance indicator development
  • Completion of cost reports (when applicable)
  • Review prior audited cost reports for possible reopening and/or appeal
  • Assist client with audits
    • Supporting communication and documentation
    • Evaluate proposed adjustments
    • Test compliance to minimize settlement errors