Hospital and physician providers are tasked with reducing Medicare denials while improving compliance. Unfortunately understanding Medicare medical necessity is a daunting chore due to voluminous, complex, constantly changing policies and regulations. Local medical review policies, or LMRPs, which determine medical necessity rules, can contain over a half million reimbursable code combinations! Many providers are overwhelmed with trying to understand the medical necessity process and are intimidated by selecting an appropriate solution that will meet their particular needs. As a result, providers are losing $100,000s to $1,000,000s of dollars in denials.

At recent engagements, Provistas found:

• A North Dakota referral center reported losing over $670,000 per year due to medical necessity losses
• Another hospital in the Midwest reported losing $100,000 per year for a single prostate screening test before recognizing their need to implement an Advance Beneficiary Notice (ABN) and properly identify diagnostic and screening tests
• A Northeast hospital demonstrated a $2 million loss in Medicare receivables over three years despite the fact that they were utilizing a back-end software solution

Provistas will identify the compliance solution that best meets your facility's needs and workflow. Provistas products and services will ensure that you will be compliant, receive full and proper reimbursement, and keep pace with the constant regulatory changes.

The Feds are getting tougher on fraud. The US Department of Justice reported that 2001 was a record year for reclaiming Federal funds obtained by fraud. Of the $1.6 billion recouped, seventy-five percent was healthcare related. Until now Medicare providers believed they had to choose between compliance and reimbursement. But Provistas products and services show that Compliance Pays™!