Gateway Home Health Recovery and Appeals Consultants:
Use their extensive knowledge to properly format and index clinical documentation at the ADR (Additional Documentation Request) level. This includes providing recommendations to address allowable alterations, identifying missing information that would normally be included within a Home Health episode of care and providing expert opinion based on Medicare Eligibility and Coverage guidelines
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.
Represent our clients with great success at the ALJ (Administrative Law Judge) level. Our consultants have prepared filings and represented providers under the following programs; Zone Program Integrity (ZPIC), Benefit Integrity and Recovery Audit Contract (RAC), Unified Program Integrity Contractor (UPIC), Targeted Probe and Educate (TPE), Third Party Liability (TPL) and more.