AppealMasters

Healthcare costs are increasing and payors are responding with increased restrictions, exclusions & limitations. Payors are constantly finding new reasons to deny and underpay claims and delay payment. As a result, healthcare providers are not collecting a large percentage of the revenue to which they are entitled.  Medicare has taken this to a new level with their Recovery Audit Contractor (RAC) program. The RACs are independent companies Medicare pays on a contingency basis to audit providers with the goal of recovering revenue for the Medicare program. Medicaid (MIC) and managed care plans are following suit with their own audit programs.  In CMS’s latest update on RACs, a whopping 85% of appeals resulted in decisions in favor of the provider.  Clearly hospitals should appeal RAC denials in most cases.  It’s your revenue, and AppealMasters is here to help fight for it!

Effective denial management demands a committed team approach, and AppealMasters has assembled the nation’s most  highly specialized team of expert advocacy resources to assist providers in responding to virtually every RAC appeal and appeal process. AppealMasters is also prepared to provide your appeals team with the necessary tools and expert education to construct a winning appeals defense. 

• APPEAL OUTSOURCING FROM INITIAL REVIEW TO THE ALJ

IHI AppealMasters provides an intensive, timely, and exhaustive appeals process invoking a combination of medical, technical, clinical and legal research to formulate a winning appeal. 

• APPEAL EDUCATION  FOR WINNING APPEALS

IHI AppealMasters’ focused goal is Performance Enhancement to prevent future takebacks and denials.  We provide Appeal Education for your staff to help construct winning appeal letters, offer appeal letter templates with input from industry experts, and provide affordable, easy-to-use and effective tools and services to correct potential flaws in current coding or clinical documentation processes.

• APPEAL LETTER TEMPLATES  SIMPLIFY THE APPEALS PROCESS

IHI AppealMasters’ team of medical necessity, documentation and coding review experts are hired by specialty to draw upon individual experiences and emphasize client partnerships. Each specialist has been actively involved in creating RAC Coding Appeal templates to support specific audit appeals.

IHI AppealMasters supports a proactive approach to denial management by providing your staff with:

• Expert opinions in each level of the Appeal Process
• Advocacy and Appeal Support until the completion of the case
• Feedback and Ongoing Identifiers of Potential Risk
• Tracking, Trending, and Statistical Analysis of Data (i.e. extrapolation)
•  Process Remediation and expertise in formulating a medical case before the ALJ
•  Educational Resources

The Result will be: 

• Improved cash flow
• Increased net revenue
• Fewer compliance concerns

Please contact mmcgraw@intersecthealthcare.com today and request an IHI AppealMasters Presentation.

“We Can Take Your Appeals to a Higher Level!”