In choosing an auditing firm, most practices prefer a consultant who is knowledgeable in their industry and understands the complexity of governmental compliance. Rose & Associates provides both. Our vast Medicare knowledge and experience in auditing ophthalmic practices has enabled us to become efficient in Medicare reimbursement and compliance.
One of the biggest assets Rose & Associates has is our personnel. Our consultants are Medicare trained and very familiar with the documentation, coding and billing of ophthalmic services due to specialization of the firm in these areas. Because of this experience, and considering the number of clients to which we provide Medicare reimbursement consulting services, all of our staff has the industry-specific knowledge to bring to an audit.
We maintain a full library and several databases of industry guidelines which we utilize for audit work, some of which are shared with our clients. Currently, we provide the following audit services:
- Medical Record Audit
- Ambulatory Surgery Center Audit
- Evaluation & Management (E&M) Services Audit
Typical on-site engagements usually include 1-2 days for small practices, and 3-5 days for larger practices. An exit conference with the doctors and staff is held on the last day to discuss the preliminary findings of the audit, and a full written report, by doctor (by patient) is forwarded to the practice usually within 45 days of the audit.
Off-site audits are conducted in our offices in Duncanville, Texas, based on information forwarded to us for review. A full written report is forwarded to the practice usually within 45 days of the audit. Service is our primary goal. As a result, we believe our clients receive a value-added audit at reasonable rates.
Medicare reimburses for services that are medically necessary, medically justified, and medically reasonable. There are times, however, when Medicare might incorrectly pay or deny a service or procedure and the only means available to the physician to receive proper payment is to appeal Medicare's decision.
Rose & Associates can evaluate the situation, determine if a second level Reconsideration is warranted, and act as the "agent of record" with a Qualified Independent Contractor (QIC) who will review the case. In the event the QIC upholds the Medicare carrier's decision, the next level of appeal is before an Administrative Law Judge (ALJ). We can assist and represent your practice in this level of appeal as well. Any additional appeals would require legal representation with Rose & Associates assisting the attorney on your behalf.
Our appeals consultant served as a Hearing Officer at a large Medicare contractor for eight years prior to joining Rose & Associates. Her extensive background and knowledge of Medicare's legislative and regulatory guidelines, while maintaining a good working relationship with Medicare carriers, has enabled her to adequately represent physicians in the Medicare appeals process.
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