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Denials & Appeals

  • 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 

  •  Current 93% success rate on Additional Document Requests (ADRs) and denied claims

  • Complete management of the appeals process with quarterly reporting on appeal outcomes and current industry denial trends

  • Expertise and on-site guidance on MAC, RAC, UPIC, CERT, and TPE levels of review.

Reviewing Reports at Desk


  • Provide thorough audits of documentation practices, standards and resident processes to mitigate risk of fraud, waste, or abuse and ensure survey readiness.

  • Ongoing training for clients regarding regulatory changes at both the state and federal level and implementation of procedures to ensure compliance.

  • Monitor professional credentialing requirements of all therapy staff and maintain ongoing licensing demands 

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