Pre-Screen and Recovery Program
Stricter enforcement of medical reimbursement policy and the changes in regulations have resulted in an increasing number of claim denials and payment recoupments due to audits. The Pre-Screen Program assists providers in keeping on top of all the changes in medical policy and claim submission requirements. The Recovery Program will assist providers with the appeals process for claims submitted that were denied due to lack of medical necessity. Through this program, we can help you collect the proper payments due that might otherwise be lost without proper follow up. Both programs can be for either initial claims submission or post-pay audits.
Services
- Documentation and Medical Necessity Review – The Orion Group will review all documents required by the funding source for the coverage and proper reimbursement of most durable medical equipment, prosthetics, orthotics and supply (DMEPOS) claims. This review/pre-screen will be based on Medicare requirements which are also used by many other funding sources. The documentation review not only verifies that the proper forms are completed, but also provides the proper codes and modifiers. We will also give you a thorough review of all pertinent medical necessity documents to insure strict adherence to Medicare policy; including “in the home” medical need. A response will be submitted to you within the guaranteed five business day turn-around. If Medicare denies your claim due to medical need, the staff at The Orion Group will work with you throughout the appeals process to ensure proper payment. This same program can be adapted for funding sources in order to assist their medical review departments.
- Documentation and Claim Review for Denied Claims – If you submitted claims in the past that were denied, The Orion Group will organize and review all documents required by Medicare for the proper coverage of most DMEPOS items. We will also determine which step of the appeals process you are in and assist you in preparing the documents required at each step. If necessary, we may ask you for additional documentation in order to ensure the effectiveness of the recovery.