 Provistas
is the industry-leading provider of Medicare medical
necessity consulting and educational services. Our
experts work with hospitals, hospital associations,
clinical practices, and other organizations to design
consulting and educational programs that make sense
for their business. Our engagements help determine
how much providers are losing due to Medicare medical
necessity non-compliance. We then provide recommendations
and conduct educational sessions for appropriate staff
such as prescribing physicians, registration, diagnostic
testing, patient accounting, and compliance.
In order to address the complexities of the medical
necessity, Provistas has formulated a Four Part Comprehensive
Consulting Program.
- Evaluation– We quantify
your losses and identify patterns and areas where
the institution is facing medical necessity denials
and non-compliance.
- Remediation– We provide recommendations
on how to avoid future denials and improve compliance
and develop workflow processes, superbills, and
computerized approaches.
- Education– We train all relevant
staff on how to utilize solutions identified during
remediation to prevent future losses.
- Amelioration– We work with your
staff to recoup medical necessity losses by appealing
medical necessity denials. This part of the program
is optional and can be engaged separately on a contingency
basis.
Central to our evaluation is examining variables
related to success such as provider relationships,
outreach facilities, and IT infrastructure. We work
with your internal experts to formulate a multi-disciplinary
medical necessity compliance plan that contains measurable
goals toward compliance and improved Medicare receivables.
Since software can play a roll in addressing these
complex regulations, working with the IT department
may be required. Nevertheless, software should only
be a part of the entire solution. Without an appropriate
compliance context, providers often misuse software.
Example
One
metropolitan area hospital wrote off $2 million in
denials over three years
using their software “solution”. Not only
did the software not increase Medicare
receivables, it facilitated illegal cost reporting.
A multi-disciplinary approach
was designed for remediation including development
of policies, processes,
and proper forms, such as superbills.
Call us at 888.288.2043 x4 or email us at
for more information or to discuss your programmatic
needs.
|
