By now your agency has made your choice in the RCD Demonstration Project. If you selected Pre-Claim review, you are finding that the process of pre-claim has required additional staffing costs for the processing of the PCR. And, you have seen a significant time delay in submitting claims as you wait for affirmations. This is true for most home health agencies entering into this new cycle of medical review.
MJS can help you save costs in operation, assure AFFIRMATION on the first submission, and most importantly, submit your claim expeditiously following the close of the billing period. Its all about process management and the human touch. And that’s what MJS offers you!
MJS & Associates have been processing PCRs for providers in Texas for the past three years. We have a near 100% acceptance rate on the first submission. That’s because our PCR team members work very closely with the agency’s intake and clinical management to assure that the required documents are not only complete, but that the documents meet the coverage requirements of the Palmetto reviewers. And we also alert to issues that could be problematic within the documents. For example, are therapy goals separated by short- and long-term criteria? Does the face-to-face contain sufficient information to support homebound and skilled need? Are the plan of care diagnoses congruent with the physician records? And much more!
MJS also offers training to your intake and clinical staff on tips to improve the timeliness of the documentation development. This training is part of the package you get with start-up. We also offer trainings throughout the contracted time to improve our relationship with you and your company.
MJS works with you to sweep your accounts for admissions and recertifications on a daily basis. Our clock starts with the admission or recert, not with the PCR submission. That’s what make our approach unique. We look for hold-ups and help resolve them with notifications to the leadership team in your agency. Once we agree with you that the episode is ready for PCR, we will audit and submit the PCR directly into eServices within 24 hours of receipt. We check status daily, and download the response letter, enter the UTN directly to your software and upload the letter to the designated areas in your software. If there is a nonaffirmed decision, we call to get it resolved SAME DAY!.
You will be given live access to our TEAM’s processing reports so you can see the status of your submission at all times. You will have extended business day access to the PCR team to communicate any issues you need assistance in resolving.
On a monthly basis, we will provide you with a PRC Tracking report that tracks the timeframe from start of care or re-certification to PRC affirmation. This report will be sent to management to help you improve your processes efficiencies and timeliness to assure that the claim can be submitted as soon as the billing period ends. There’s the cash flow piece that helps you the most.
Call us today to see if you qualify for our discounted rate!
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