Reimbursement 

Overview:

Harmony Healthcare International (HHI) brings an in-depth knowledge of the governmental reimbursement process, federal and state regulatory requirements, denials/appeals management and prevention, financial and clinical challenges.

Our HealthCARE Specialists have experienced clinical backgrounds combined with comprehensive, operational knowledge of the financial and management processes needed to ensure accurate and appropriate governmental reimbursement. Harmony Healthcare International (HHI) provides education directed from the Medicare Benefit Policy Manual, the Medicare Claims Processing Manual, the State Operations Manual and the Resident Assessment Instrument Manual. Information is extracted and distilled for relevancy related to customer specific focus areas.

Securing accurate reimbursement in the Post-Acute arena can be particularly challenging due to:

  • the complex nature of the care and services provided to each patient; 
  • the complex methodologies that are required for each payer; 
  • the number of varied employees that contribute to the process
  • the systems and tools used to capture and process the data required for each patient's payment for care/services and 
  • the financial, regulatory and civil penalties associated with non-compliance combined with the unending variation that occurs in each of these dimensions.

Harmony Healthcare International (HHI) offers consulting services in the following areas of reimbursement:

  • Medicare
  • Part A
  • Part B
  • Consolidated Billing
  • Medicaid
  • Case Mix
  • MMQ
  • OMIG
  • Managed Medicaid
  • Managed Care
  • Accountable Care Organization
  • Revenue Cycle Management
  • Pre and Post Pay Claims Review and Preparation
  • Appeals and Denied Claims Management
  • Expert Witness Services
  • Value-Based Purchasing
  • Comprehensive Joint Replacement

In the Post-Acute Setting, Medicare reimbursement is dependent on the understanding and identification of each beneficiary's Medicare eligibility, entitlement and coverage criteria combined with the delivery of quality care. Harmony Healthcare International (HHI) provides a focused analysis of the Medicare services with a review of MDS, documentation, billing and compliance risk areas along with identification reimbursement oversights ultimately facilitating appropriate corrections and rebilling. Harmony Healthcare International (HHI) provides education directed from the Medicare Benefit Policy Manual, the Medicare Claims Processing Manual, the State Operations Manual, and the Resident Assessment Instrument Manual that is pertinent to the issues identified.

Reimbursement services include guidance in the Medicare Part A, Medicare Part B and Consolidated Billing realm.