The Healthcare Provider's #1 Medicare Audit Defense & Medicare Appeals Resource
Medicare Audit Defense - Medicare Appeals - CMS Program Integrity Resources

Medicare Audit Defense - Medicare RAC Appeals - Medicare Mock Audits

Jackson Davis HealthCare leads the nation in building winning Medicare appeals cases.  As your unwaivering advocate, Jackson Davis assists providers in building rock-solid medicare appeals cases and defending against potential Medicare fraud allegations.  Using Medicare coverage criteria as the foundation, our professionals assist in all aspects of Medicare audit defense.

For over 25 years, Jackson Davis professionals have dedicated every day to understanding, documenting, synthesizing and applying Medicare coverage criteria to cases conditionally denied by Medicare contractors - MAC audits, RAC audits, ZPIC audits and DOJ audits.

2012 Medicare Self-Audit Templates - Are you looking to build a rock-solid internal audit & compliance program using Medicare coverage criteria as a foundation?  Have you been conditionally denied payment from a Medicare contractor and want to build winning appeals?  The 2012 Medicare self-audit templates are perfect for use by internal auditors and compliance professionals when reviewing home health episodes and building winning Medicare appeals.  These detailed, self-audit templates are now available for purchase by healthcare providers nationwide.

Medicare "Additional Documentation Request" Response (RAC auditor ADR response) - A provider's initial ADR response is THE most critical stage of the Medicare audit process.  Based upon our 25 years of Medicare audit experience, the vast majority of all cases can be won or lost at this crucial stage.  Jackson Davis professionals are experts at developing a cohesive and winning approach to responding to RAC auditor requests for documentation.  NO ONE will give you a better chance to address and eliminate additional Medicare audit threats.

Medicare Appeals (RAC appeals) - Over the past 25 years, Jackson Davis professionals have worked with providers and attorneys nationwide to appeal 1,000s of Medicare overpayment issues.  JDH partners with providers and law firms to analyze, develop & build winning Medicare appeals cases.  Our board-certified physicians, legal nurse auditors and industry-leading compliance staff are unmatched in Medicare audit defense and the submission of winning Medicare appeals.  Simply put, NO ONE will give you a better chance to succeed at your Medicare appeals.

CMS Compliance Advisory Services - Providers nationwide retain JDH for monthly audits, compliance advice or on a project-by-project basis.  Our staff is highly experienced and our knowledge and application of Medicare rules and regulations is unmatched in the industry.  We are true Medicare compliance geeks.  From our physicians to our nurses to our compliance reseach team, we are in your corner and available 24/7 for your CMS compliance needs.

Mock Medicare Program Integrity Audits (Mock PI Audits) - Jackson Davis HealthCare assists providers in completing proactive, medical records audits versus Medicare coverage criteria - Medicare Program Integrity audits (or "Mock" PI Audits).  Each Medicare PI audit is based on documented, CMS payment criteria and Medicare coverage criteria for selected focus areas and may include a sampling of 10 - 500 patient encounters.  Each encounter is pre-screened and carefully selected based upon Medicare current or anticipated audit focus areas.
_______________________________________________________________________________________

Mock Medicare Program Integrity Audits (Mock PI Audits)

Jackson Davis HealthCare assists providers in completing periodic medical record documentation reviews versus current Medicare coverage criteria.  Each Medicare mock audit is based on current (or timeframe applicable) Medicare coverage criteria for selected Medicare audit focus areas and can include anywhere from 10 - 500 cases per review.  The focus of each mock audit is determined at the provider's request and typically involves select Medicare audit areas of perceived or possible financial exposure to recoupment.  The following is just a sample of our 2011 - 2012 Medicare mock audits:

Sample of Jackson Davis Medicare Mock Audits for 2011 - 2012:

                PCI / ICD / Pacemakers (surgical procedures in wrong setting)
                Home Health Agency admissions (homebound status and medical necessity)
                Skilled Nursing Facility admissions
                Short stays (chest pain & chest pain related diagnoses)
                Pneumonia diagnosis code sequencing
                Physician E&M coding
                Hospice admissions (medical necessity)
                Respiratory care with ventilator diagnosis code sequencing
                Inpatient Rehabilitation Facility admissions
                Outpatient physical therapy visits
                Use of modifier 25
                Wound care clinic and procedure billing
                Emergency Room visit criteria and CPT code selection
                HME supplies (billing and medical necessity)
                Excisional Debridement Impacted MS-DRGs
                Extensive O.R. Procedures Unrelated to PDX
                Portable Radiology visits & billing
                Neulasta billing & documentation
                Septicemia diagnosis code sequencing

Based upon the number of records being reviewed and scope of the Medicare audit focus areas, Jackson Davis mock audits are traditionally completed over a 2 to 8 week time frame.  Each in-depth audit incorporates 5 major assessment components - billing, coding structure, documentation, claim submission & medical necessity.

All Medicare mock audits are completed by our industry-leading board-certified physicians, legal nurses, case management specialists and Medicare billing & documentation compliance professionals.  Each audit finding is supported by an extensive & wide range of formal documentation resources authored by or reviewed on behalf of the Centers for Medicare & Medicaid Services.