Retrospective Governmental Payor Appeals Management|
EHR Physician Advisors have extensive experience with all stages of the governmental payor appeals process and have achieved unmatched success in identifying and obtaining the reversal of thousands of inappropriate RAC, MAC, MIC, and QIO medical necessity denials at all levels of appeal. EHR's methodology combines expert physician clinical expertise, focused on medical necessity, with legal and regulatory arguments so all appeal avenues are explored.
- Medicare & Medicaid Denials & Appeals Management
- Recovery Audit Contractor Denials & Appeals Management
- Medicare Administrative Contractor (MAC), Medicaid Integrity Contractor (MIC), Quality Improvement Organization (QIO) Denials & Appeals Management
EHR conducted nearly one-third of all medical necessity appeals filed from the RAC demonstration project on behalf of its client hospitals and has achieved high overturn rates. In most cases, EHR manages the entire appeals process through all levels of appeal, including preparing briefs and presenting evidence to Administrative Law Judges (ALJ), a level at which EHR has experienced tremendous success.
EHR's in-depth understanding of the Social Security Act, Code of Federal Regulation and CMS Manual and Ruling guidance results in superior appeal outcomes and allows for a coordinated process with its clients' case management, compliance, and legal departments.
Click here to read about EHR and Bon Secours St. Francis Health System's appeals success in the January 2010 issue of Hospital Case Management.
Contact EHR to learn more about its Retrospective Governmental Payor Appeals Management solutions.