Client Overview

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.

Business Challenge

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.

How Do We Help with Pre-Claim Reviews?

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.


Review Choice Demonstration – Pre-Claim Review, Packaging and Submission

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:

  • Red Road helps to clear 400 claims monthly with an affirmed UTN.
  • A significantly improved and consistent affirmation Rate of 98% due to the extensive review and feedback process, ensuring all relevant information is in the package prior to submission.
  • Improved office efficiency, as the packaging of charts is handled by Red Road.
  • Red Road reviews identified deficiencies which enabled the client to give specific feedback to their clinicians, resulting in consistent improvement in documentation and clinicians feeling more supported by the client.
  • The Red Road team helped the client to avoid write offs.
  • The client was put on track to come out of 100% PCR 6 months after commencing reviews with Red Road.

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