Jackson Davis HealthCare
Medicare Audit Defense,
Medicare Appeals & ZPIC Shadow Audits
Contact us at (303) 586-5003
The Healthcare Provider's #1 Medicare Audit Defense & Medicare Appeals Team
ZPIC Audit Defense - ZPIC Appeals - Medicare Shadow Audits
Medicare Audit Defense - Medicare ZPIC Appeals - Medicare Shadow 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 - ZPIC audits, MAC audits, RAC audits and DOJ audits.
Medicare Appeals (ZPIC appeals) / Medicare Shadow Audits - Over the past 25 years, Jackson Davis professionals have worked with providers nationwide to appeal 1,000s of Medicare overpayment issues and win close to 90% of all cases. JDH partners with providers 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.
Medicare "Additional Documentation Request" Response (ZPIC auditor ADR response) - A provider's initial ADR response is a critical stage of the Medicare audit process. Jackson Davis professionals are experts at developing a cohesive and winning approach to responding to ZPIC auditor requests for documentation. NO ONE will give you a better chance to address and eliminate additional Medicare audit threats.
2013 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 2013 Medicare self-audit templates are perfect for use by internal auditors and compliance professionals when reviewing potential Medicare focus areas and building winning Medicare appeals. These detailed, Medicare self-audit templates are now available for purchase by healthcare providers nationwide.
Mock Medicare Program Integrity Audits (Mock PI Audits) - Jackson Davis HealthCare assists providers in completing proactive, medical records audits versus Medicare coverage criteria - mock Medicare program integrity audits (or "Mock" PI Audits). Each mock 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.
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. Hospital appeals, physician appeals, SNF appeals, home health appeals, hospice appeals and DME supplier appeals - call us today and put Jackson Davis to work for you!
Internal Audit & Medicare Physician Advisor Program Development - Are you looking for a helping hand in developing or revamping your internal audit or Medicare physician advisor programs. Are you looking for a reliable resource to work as a true partner in the process of adopting a more structured foundation built on Medicare coverage criteria? Are you uncomfortable about facing prepay audits or want peer review of your external physician advisor group? Jackson Davis is the solution. Our board-certified physicians really do understand Medicare coverage criteria and they work closely with our legal nurses and regulatory team to bring compliant solutions to providers everyday.
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 mock Medicare 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 2012 - 2013 mock Medicare audits:
Sample of Jackson Davis Mock Medicare Audits for 2012 - 2013:
PCI / ICD / Pacemakers (surgical procedures in wrong setting)
Home Health Agency admissions (homebound status and medical necessity)
Skilled Nursing Facility admissions (Part A and Part B)
Short stays (chest pain, syncope, dehydration, etc.)
Pneumonia diagnosis code sequencing
Physician E&M coding (hospital inpatient, office visits, testing, etc.)
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
DME 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 (ICD-9 sequencing)
Facet Joint Injections
Spinal Infusion (medical necessity & ICD-9 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 mock Medicare 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.
Hospital appeals... Physician appeals... SNF appeals... Home Health appeals... Hospice appeals... Physical Therapy appeals... DME appeals... Jackson Davis is in your corner!