Expert TPE/ADR Medical Records Review and Compliance Support
Let our experienced team help you manage the complex and burdensome process or tracking, responding to and appealing TPE, ADR, SMRC and other record reviews.
Medical record reviews are back in full force with both prepayment and post payment TPE (Targeted Probe and Educate), ADR (Additional Development/Documentation Request) and SMRC audits just the beginning of these audits. Not all agencies will receive these requests, but if your agency does receive a claim audit, your response is critical. Failure to respond and late responses result in automatic claim denials. Weak or incomplete responses can tie up your revenue for months, leading to cash flow problems. Poor outcomes (high error rates) can ultimately lead to Medicare additional actions that might include 100% pre-pay review, extrapolation, referral to RAC auditor, or even more severe consequences.
Each of the MACs has set a different compliance threshold (maximum denial percentage):
It is critical that your organization meets the compliance threshold on the first level of review to reduce reduction in cash flows and lengthy appeals. Rapid, thorough record review and response is only one key factor in reducing error rates. Claim Review response is more than putting your documentation into a folder and submitting it; you need an organized approach to record aggregation and presentation of records prior to submission. If you do need to move to appeals, having a clinical team of experts on your side will help you develop and present your arguments to best position for the denials to be overturned.
While we understand that your team knows about hospice, we also know that many hospice leaders have never been through this process and inexperience can and will impact your outcomes. Our team is highly experienced in responding to initial claim audits, writing and managing appeals at all levels and helping you manage the complex and burdensome process of tracking, responding to and appealing TPE (Targeted Probe and Educate), ADR (Additional Documentation/Development Request), CERT (Comprehensive Error Rate Testing), SMRC (Supplemental Review Contractor) and other record reviews. The Hospice Support Specialists medical claim review team is composed of experienced Registered Nurses who are experts in medical record review and in the development of quality clinical responses.
Our TPE/ADR audit services are customizable from simple team education to complete project management. Hospice Support Specialists can maximize your reimbursement, shorten the TPE cycle and minimize potential recoupment and risk. We are experienced in working with all the MACs.
Hospice Support Specialists offers the following audit related services:
If you are seeking to be proactive and manage your TPE/ADR outcomes before you get a Claim Review, Hospice Support Specialists offers many trainings for your team, to ensure that you are prepared. Below is just a short sample of the trainings our team can offer to your team:
Whether you have received notice of a TPE or other claim review or want to be proactive and ensure your records are compliant, HSS teammates are available to support.
