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This client is home health care provider in the United States. They offer a wide range of home care services, including home health and skilled nursing services.
Red Road Health Solutions offers excellent clinical and non-clinical back-office support solutions to home healthcare providers and understands payor specific, federal and state requirements for pre-claim reviews for Review Choice Demonstration, Medicare ICD 10 coding, and RCM. We were enlisted to work directly in the client’s EMR, thus improving the efficiency and effectiveness of the review process.
The home health claims from this client had issues during the initial Pre-Claim Review (PCR) cycles, as they had multiple deficiencies with the face-to-face documentation, orders and SMART goals, due to inconsistencies in the interpretation of the payer (Palmetto) requirement. To address this on an ongoing basis for this client, Red Road carries out a complete audit (100%), which enables the client to continuously monitor the documentation process and significantly reduce the risk of denials.
The client had issues with the initial PCR cycles with an affirmation percentage of less than 85%. Red Road has been providing pre-claim reviews, packaging and submission of charts for our client under the Review Choice Demonstration (RCD). The client has been able to meet the following goals with Red Road’s support:
