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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:
Efficiently managing claims rejections plays a pivotal role in ensuring the financial stability and credibility of healthcare providers.
Choosing between in-house coding and outsourcing is a critical decision for healthcare providers, balancing cost, quality, and operational efficiency.
Maintaining GDPR and HIPAA compliance in hospice data management is crucial for protecting patient privacy and ensuring the security of sensitive health information.
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Elevating hospice care requires a multifaceted approach, with a key focus on effective revenue cycle management.
Claims Rejection
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OASIS (Outcome and Assessment Information Set) review is a critical component in home health care
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Data-driven decision-making is revolutionizing home health care by providing insights that enhance patient outcomes and operational efficiencies.
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Navigating the intricacies of hospice documentation presents healthcare providers with a myriad of challenges that can significantly impact the quality of patient care
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Addressing staffing issues in healthcare through attrition analysis is a critical strategy for maintaining a stable and efficient workforce.
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Reducing billing errors is paramount for healthcare providers, especially in home health care and hospice services.
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Medical coding is the backbone of healthcare billing, translating complex medical procedures, diagnoses, and equipment into standardized codes used for billing and insurance purposes.
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In the ever-evolving healthcare field, particularly within home health care and hospice services, managing insurance denials remains a significant hurdle for providers.
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Home health care providers face unique challenges that underscore the need for specialized coding services.
The ability to harness the power of data has become a critical driver of success for home health care providers.
Healthcare providers face many challenges, from complex billing processes to stringent compliance requirements.
Achieving and sustaining revenue goals is an ongoing challenge. Accurate and efficient medical coding cannot be overstated.
In today's complex healthcare landscape, maintaining regulatory compliance is paramount for any healthcare organization
In the intricate landscape of home health care, the accurate and efficient coding of medical procedures, diagnoses, and services is paramount.
Medical coding is crucial in home health care by translating complex medical procedures, diagnoses
RCM Pre-Authorization Highlights Client OverviewThis client is a mid-sized home care provider in the
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Many home care, home health, and hospice providers have not had the scope and ability
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As a home health provider, you have a 76-year-old male patient, who needs substantial care at home.
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