Medical and Claims
Review and Education
Funding sources come up against more and more hurdles as they attempt to provide the proper benefits to their beneficiaries. They are required to stay within budget, and asked to save money where they can. They must make proper coverage decisions, understand ever-changing policies, stay up-to-date with new products and withstand their own internal audits. In addition, they must still meet the ultimate goal of providing the proper equipment to meet their beneficiaries medical needs. When it comes to specialty high-end products such as complex rehab power wheelchairs, the staff may not have the extensive knowledge needed to make appropriate decisions on many of the items submitted for claim payment.
- Medical and Claims Review Training Sessions - The Orion Group can conduct training sessions to provide your medical review and claim processing teams with the knowledge to properly adjudicate claims. This training is done by tying the product and medical policy together. This allows your staff to fully understand how all the parts and pieces tie together and what type of documentation they should be looking for. A funding source’s success is determined by making proper payments or denials without having to review the same claim numerous times. This program can be conducted in-person or online and can be customized to your desired product categories.
- Claims Review - As staff sizes are reduced and turnover grows, many funding sources are looking for assistance in the review of submitted claims, specifically for complex orders. The Orion Group can assist in these reviews and provides a guaranteed turn-around time for completion of services.