Gateway Home Health Coding and Consulting can provide solutions and education to better manage your Review Choice Demonstration, regardless of the choice made or delegated. Our Clinical experts can provide an orientation to the entire process, which includes the practical application of managing your episodes under review. At any point you may utilize the following services:
Pre-Submission Review of Clinical Records (Pre-claim)
Review and Guidance of Non-affirmed claims
Training based on Common or Complex Denial Reasons
Just a few of the benefits to using our RCD program and consulting:
Initial Guidance and Workflow to ease your operations.
Review of non-affirmed pre-claim submissions to speed up affirmation and billing. If chosen, assistance with ADR/RCD submissions including guidance on any unfavorable results.
Improved odds on appeal should the claim be requested at a later date.
Knowing ahead of time the clinical deficits that may affect payment.
Our vast Experience and Expertise can be your asset when navigating RCD!
We manage redetermination and mid-level appeals for Medicare, Medicaid and other payer types. Utilizing Program Integrity and Benefit Policies, along with our years of experience, we are able to consistently rebut and provide evidence to support claim payment. By providing accurate rebuttals we are able to further increase the success rate moving towards ALJ. Over the years we have represented our clients with great success at the ALJ (Administrative Law Judge) level. Our consultants have prepared filings and represented providers under the following programs; Benefit Integrity and Recovery Audit Contract (RAC), Unified Program Integrity Contractor (UPIC), Targeted Probe and Educate (TPE), Third Party Liability (TPL) and more.