Effective therapy medicare denials management demands a committed team approach. Halcyon Rehab unites with our long term care providers in a team approach to denial management and compliance. This approach allows for effective management of Medicare Appeals and increases the success rate of payment and favorable claims at all levels of the Medicare Appeals process. Our Medicare Appeals and Medicare Compliance department stays up to date on the latest regulatory changes, correct coding and billing initiatives, and compliance with documentation standards.
As a valued team member we work closely with customers to ensure efficient communication of ADRs and Medicare Denials. Our Medicare Appeals & Compliance Coordinators (ACC's) are the centralized contacts for all ADRs, Medicare Denials, reviews, and Medicare Appeals. A systematic protocol is utilized by our Medicare Medicare Appeals & Medicare Denials department in order to streamline communication, ensure timeliness of denial and appeal submissions and decisions, and to ensure a high appeal success rate. The Halcyon ACC's work and communicate directly with the customer in order to capture accurate information related to denied claims. Our ACC's maintain a detailed tracking log of all ADRs, denied claims and Medicare Appeals, both in our Casamba software system and manually. The ACCs collect required documentation from the facilities, review the documentation for accuracy and completeness, and provide specific feedback on any required enhancements to the documentation.
We support a proactive approach to denial management by providing:
As an organization our goal is Performance Enhancement to prevent future Medicare Denials. We have developed effective tools and services to correct potential flaws in current coding or clinical documentation processes. Our teams demonstrate consistent success with overturning unfavorable determinations and payment of reviewed claims. Over 90% of claims in question result in payment.