HEALTHCAREfirst Announces Business Intelligence Enhancements That Help Reduce Medicare Denial Rates

Earlier this year, Palmetto GBA announced new medical prepay audits based on certain HIPPS codes that have the highest denial rates. While they have internally identified the top 20 HIPPS groupings with the highest denial rates, they have currently published and set up pre-pay audits for two code groupings. When an End of Episode (EOE) claim is submitted using one of these two HIPPS groupings, Palmetto GBA could place the claims into ADR status and providers will be required to submit additional documentation from the chart in order for a payment determination to be made.

In response to this announcement by Palmetto GBA, HEALTHCAREfirst developed Business Intelligence reporting that will enable home health agencies to identify and monitor episodes that will be audited upon EOE submission. Agencies can then focus on the charts that make up these at-risk claims, ensuring that their documentation is accurate and complete should the claims go into ADR status.

In addition, HEALTHCAREfirst has expanded the HIPPS code groupings beyond the two identified by Palmetto GBA to include ten additional code groupings that may be subject to audit, based on internal statistics. This assists home health agencies in preparing for potential upcoming audits, regardless of their MAC. In addition, Episode Master, the automated QA tool within Business Intelligence has received a number of enhancements that include more detailed messages and suggestions to help protect agency review and ensure documentation is as accurate as possible due to increased industry scrutiny. These edits focus on many of the issues that typically result in take backs when agencies are targeted.

“Like never before, home health agencies must know where their money is at all times in order to avoid interruptions in their revenue cycle. These new enhancements are important additions to our Business Intelligence analytics tool, providing the information needed to make informed business decisions before it’s too late,” said Stan Bell, Vice President of Product Management.

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Integra Global

 

Compare Integra Global International Health Insurance Quotes

Health plans from Integra Global allow your staff complete freedom of choice for doctors, specialists and hospital providers, worldwide. Let international medical insurance cover your staff while they are temporarily back in the U.S. and Canada. Our network of hospitals and doctors serves as a passport to the largest health network in North America. For our international health insurance customers, our global support service means that your staff can rely on the best care, worldwide: when the need it, where they need it, in some of the world's leading centers of medical excellence. While your staff members are assigned abroad, you don't want to worry about what their international health insurance policies cover.

Instead you need a comprehensive cover that takes care of the big things as well as the small. Medical evacuation, travel assistance or claims translations, not features you would normally find in a straightforward domestic plan but all essential in an expatriate medical insurance for your international based staff. And we have the comprehensive cover that you would expect from a quality health plan such as chronic conditions cover, hospitalization, prescription drugs, out-patient, wellness benefits, and physician office visits to name just a few. Integra Global utilizes the UnitedHealthcare Network.

Plan 1 members have access to 5,200 hospitals and 650,000 health care professionals through the UnitedHealthcare Network. All treatment in the U.S. must be pre-certified. Make sure your provider pre-certifies your medical treatment. Utilizing the UnitedHealthcare network simplifies your pre-certification process and claims filing.

Company: Integra Global

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Germany: 06221 825 650

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Website: www.integraglobal.com

Compare Integra Global International Health Insurance Quotes

 

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You Are Global

You Are Global Overseas Health Insurance

 

You Are Global is a leading international health, expat, life and travel insurance broker and intermediary, based in Brazil. You Are Global works with leading private medical insurance providers and companies like IMG, Cigna, HCC, Now Health International and Allianz Worldwide Care. You Are Global caters specifically for expatriates, travelers and tourists, working, living and visiting Brazil. You Are Global has specific expertise working with Spanish speaking cultures around the world whilst also proving international health, medical, travel, expat and life insurance plan to the out bound travel market in Brazil.

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ALC Health

à la carte healthcare (ALC Health) is an award winning international medical insurer who for over 10 years has been protecting the health of private clients, companies and organisations across the globe. The company continues to grow and develop on a philosophy of ensuring that every policyholder whether as a private individual or a member of a corporate group is assured of the highest level of personal service and support.

With many of ALC Health’s employees having both lived abroad and gaine