Medical Review Consulting
HPS has a team of experienced reviewers that have led agencies across the country through numerous levels of review.
Critical Medical Review Assistance for Your Home Care or Hospice Agency
Home care and hospice industries are subject to multiple layers of review by government contractors. This is an ongoing process, and a critical need, where your agency may need guidance to prevent inaccurate results and a negative effect on your agency’s operations.
The HPS medical review consulting team can assist with reviewing charts that have been selected for Targeted Probe and Educate (TPE), Additional Development Request (ADR) reviews, Recovery Audit Contractor (RAC) reviews, Supplemental Medical Review Contractor (SMRC), Comprehensive Error Rate Testing (CERT) reviews and Unified Program Integrity Contractor (UPIC) reviews.
These reviews can impact the agency from a cash flow/revenue standpoint and will hold agencies to the documentation requirements of the Conditions of Participation and Conditions of Payment.
CMS has allowed post payment reviews to resume. As a result, the number of reviews being performed has increased immensely. HPS equips agencies to not only be successful at completing paperwork to submit for reviews, but to be successful at decreasing denial levels with education on improving documentation.
HPS medical review consulting provides guidance on every level of the appeals process, through and including ALJ appearances, if necessary.
Empower Your Agency with Our Team of Experienced Clinicians
Healthcare Provider Solutions CEO, Melinda A. Gaboury, shares a look at our primary goals when supporting home care and hospice agencies on the clinical level.
Tips for Success
All three Medicare MACs and third party contractors can receive medical records for review by electronic submission. If your agency has not yet enrolled in the electronic submission of medical records, we recommend implementing that process as soon as possible. It is much easier to prove timely acceptance of the record when the record is submitted electronically to the MAC.
Both home care and hospice agencies should make sure that they have an organized process of checking for ADRs, including who has been assigned to clinically review the chart once it is assembled. Agencies really need to be successful in the first level of review and not be moved into a second round that could force 100% reviews.
- Providers targeted for medical review have been receiving notification letters about the review and typically a list of patients and dates of service to be reviewed. Ensure that everyone knows where the letter needs to go for appropriate action.
- Providers should ensure that medical records are submitted promptly upon request. Providers’ nonresponse to medical records requests will count as an error. This can trigger an automatic escalation of review of your agency and potentially a referral to one of the other contractors.
- There should be a detailed clinical review of the chart prior to submission. Never just throw the chart together and send it on its way.
Recent Articles Written by Melinda A. Gaboury, COS-C
In mid-November, Hospice Preview Reports were released containing information about your Hospice. The information in these reports will be made available as part of the February 2024 refresh of the Care Compare website. Between November 15 and December 15,...
The Home Health Final Rule for 2024 that was published November 1, 2023 contained many changes – including ones that will specifically impact the Home Health Value-Based Purchasing Model in 2025. The Value-Based Purchasing Model in 2023 will remain unchanged in...
The VBID (Value-Based Insurance Design) model is a voluntary program where Medicare Advantage Organizations submit an application and undergo a bidding process to participate in the demonstration. In January of 2021, the Hospice benefit was added to the VBID...
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Why Agencies Choose HPS
“Melinda, Mark, and their staff are professional, honest, responsive, and true thought leaders. Their expertise enabled our agency to realize significant cash flow improvements and clinically focused operational advancements.”
“It’s so reassuring to have experts managing our accounts and know that it’s being done ethically and ‘by the book.’ Our days in AR have never been so low. “
Home Care Agency Director
“HPS helped me reduce my aging by $140,601. Thank you sounds kind of hollow for such a feat, so I will capitalize it: THANK YOU!”
Colorado Hospice Provider
Healthcare Provider Solutions proudly affiliates with the national Home Care & Hospice Associations and many state associations.
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Provider Solutions Professional
MELINDA A. GABOURY
Chief Executive Officer
Director of Clinical Services