Compliance Checking

Enhances productivity and verifies medical necessity

All Medicare claims must reflect reasonable and necessary services ordered by a licensed medical professional, and false or fraudulent claims can result in penalties. Through medical necessity checking prior to providing services, Compliance Checking plays an integral role in your efforts to promote accurate Medicare billing information and regulatory compliance.

• Simultaneously verifies medical necessity for Medicare Parts A & B outpatient services prior to service
• Imports charge master and other information
• Clarifies patient obligations and immediately generates ABNs
• Improves compliance and reimbursement with regular updates to CCI and OCE edits, modifiers and codes
• Incorporates LCD and NCD guidelines
• Provides user-defined "quick lists" of frequently checked procedures and descriptions to enhance productivity
• Helps reduce bad debt, denials, write-offs and A/R days while achieving maximum reimbursement

It's all in the Network

Performance Management Dashboard
Billing Management
Patient Management

For more information, contact us via the Web or call us at 1-800-508-8494.