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What We Do
• Consulting and training, educational and compliance purposes on site or remote
• Review and organize medical records. Determine if greater specificity is needed in the documentation
• Uncover the type of denial by Medicare including: Additional Documentation Requests (ADR), Pre-payment probes, Comprehensive Error Rate Testing (CERT) Audit, Recovery Audit Contractor (RAC) Overpayments and stopping Recoupment, and Medicare
Administrative Contractor (MAC) denials
• Attorney written appeals for all
levels including initial and pre-determinations, Redetermination, Reconsideration, and Administrative Law Judge (ALJ) review
• Monitor Appeal Deadlines
• Prepare legal memorandums and briefs at the Administrative Law Judge (ALJ) level
• Help organize and inform on the process of an Administrative Law Judge (ALJ) hearing
• Provide a regulatory advisor during an Administrative Law Judge (ALJ) hearing
Who We Do It For
• Any Orthotic and/or Prosthetic Company in any of the 50 states and 5 territories
How We Do It
• Medical Records are submitted through either
1. Secure HIPPA Web Portal or
2. by fax or
3. secure email
• Attorney written appeals are faxed or mailed within their designated timeframe to their designated Medicare Administrative Contractor (MAC) or Qualified Independent Contractor (QIC) with jurisdiction
Benefits
• Allows O&P companies to monitor cash flow
• Permits O&P companies to focus on patient care
• Makes time available that is better utilized through leisure activities once enjoyed
Basic Price Structure
• Pre-payment probes/ADR requests range from $40.00 per claim or 5% over $1,000
• Redetermination and Reconsideration are packaged together
i) Orthotics and Prosthetics are priced separately
ii) Bundled claims are discounted
• Administrative Law Judge (ALJ) level of appeal priced separately
• Additional Documentation Requests
-Fee for Service (pay as you go)
-$40.00 per case or if it's over $1,000 (5%)
• Pre-Payment Probe
-Fee for Service (pay as you go)
-$40.00 per case or if it's over $1,000 (5%)
• Appeal Levels-Redetermination & Reconsideration
-Orthotics
i) $75.00 per case
ii) $150.00 for bundle of 3 cases
-Prosthetics
i) $200.00 per case
ii) $500.00 for bundle of 3 cases
• Appeal Levels-Administrative Law Judge (ALJ)
-Orthotics
i) $200.00 per case
ii) $500.00 for bundle of 3 cases
-Prosthetics
i) $450.00 per case or 5%
ii) $1250.00 for bundle of 3 cases or 5%