Revenue Cycle Management Services
A standard appeal is done when all levels of “expedited” servicing have been exhausted. The remaining option is to perform a standard appeal. At this point, the documentation is to be forwarded to the insurer for review, and a determination will be made in retrospect as to the medical necessity that was present at the time services were rendered.
Insurance Conscious Charts Training and Consulting
All HIM Services provided by best experienced Employee.
This is the process of securing ongoing authorization for patients already in care, this also includes step downs and step ups in levels of care. This is where the information presented during precertification is further explored and elaborated upon and is pivotal in setting up ongoing authorizations as well as establishing a good basis for long care in alternative levels of care.
Verification of Benefits
Verification of benefits is the process of determining if a patient’s policy allows coverage at your facility. It also can reveal telling information about likely reimbursement amounts, policy history and even patient history if you are able to ask the right question. Zmedcare provides thorough, accurate and precise verifications of benefits both during business hours and after business hours. We provide precise verifications swiftly because we understand that minutes may make the difference between admitting a patient, and that patient going elsewhere. Our proprietary forms allow us to collect consistently accurate, reliable and in depth verifications every single time.
Peer reviewing and expedited appealing is the process of requesting reconsideration of an adverse determination (IE: denial of authorization). A peer review is the first level of “reconsideration” and if this proves unsuccessful, then an expedited appeal is requested. At this point, it is imperative that you have an excellent understanding of medical necessity, the right documentation and the right person advocating for your clients.
This is the process of obtaining initial authorization after a client admits to your facility. This is the review that is going to set the pace for the rest of the course of treatment, information presented during precertification will identify the presenting problems and key pieces of information in establishing medical necessity and ultimately in length of stay. With immense experience in substance abuse UR at all levels of care we maximize days and insure that your patients get the care they deserve, and you get paid to render it.