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Wellness Wise Solutions can assist your agency through the ADR process and the redetermination and reconsideration levels of appeals to ensure a timely and effective response at each of these crucial Pre-ALJ stages. Our ADR and Medicare Appeals Services assist by ensuring that all supporting clinical documentation submitted is correct, complete, and concise with initial submission to the MAC or oversight contractor. This service includes a written clinical summary to support homebound and medically necessary services at redetermination and an argumentative rebuttal brief for unfavorable determinations that appeal to the 1st and 2nd level of the CMS appeals process.
Wellness Wise Solutions provides Pre-claim Review (PCR) audits to ensure clinical and billing compliance with Medicare regulations is met prior to claim submission. This is a pre-bill service that provides a meticulous review of all clinical documentation that is present in the medical record to support the 30-day claim period. This review always includes FTF encounter compliance and all service assessments, evaluations, daily notes, communication notes, and miscellaneous items like physician follow-up encounters, labs, etc. It includes a comparison of the medical record documentation to the UB-04 claim to ensure the claim is accurate and supported.
