Pre and Post Pay Claims Review & Preparation
It is common practice for providers to receive communications from Governmental review agencies and Managed Care Plans requesting proof of the provision of skilled services in the form of an Additional Documentation Request (ADR), Help Letters, etc.
Pre-payment and post-payment insurance claims reviews are not classified as a denial of payment until the record is reviewed and denied. Prompt attention to managing these inquiries is essential for cash flow and prevention of higher volume record requests.
How can Harmony Healthcare International (HHI) help?
Harmony Healthcare International (HHI) devised a unique approach to preparing and submitting medical record documentation. Our HealthCARE Specialists assist providers with swiftly recouping and preventing denied claims. We assist providers in implementing systems that ensure timely, thorough and accurate responses to the claims inquiry process.
Our HealthCARE Specialists help develop patient specific Proper Reimbursement Explanation Paper (PREP) letters. These letters detail, describe and reference the rationale for skilled services and enhance the reviewer's understanding and justification of services provided.
While completing the above process, Harmony Healthcare International (HHI) simultaneously identifies possible risk areas and causes for review (ICD-10 ordering, PEPPER metrics, etc.). At this time, prevention strategies can be implemented at the provider level. Our services include:
- Develop a tracking system for timely claims review and submission
- Assist in coordinating the Medical Record documentation collection process
- Prepare claim specific Proper Reimbursement Explanation Paper PREP letter(s)
- Identify potential causative factors related to the origin of the inquiry
- Review claim for completeness prior to submission to the review agency
- Claim reviews may be completed On-site and/or Off Site
- Identification of prevention strategies
- Education of prevention strategies
- Executive summary of findings (may include qualifier grid)