Clinical Compliance Review

Clinical
Compliance Review

We will take care of the complexities of compliance, so that you can stay focused on what you love – providing compassionate, high-quality services to your clients. We offer a reliable and proven medicare-compliant avenue for your compliance reviews.

Our comprehensive review of documents from the client and the clinician ensures that you stay compliant with the medicare conditions of participation and minimize any potential risks in audits. Our team of highly experienced clinicians ensure a thorough and accurate end-to-end check.

We only employ registered nurses with a master’s degree to perform chart reviews. Red Road reviews cases remotely and performs all reviews using our Quality Review Tool software. 

Home Health Coding Services In USA
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We employ our proprietary four-pronged approach to deliver high-quality services to our clients at all times.

COMPREHENSIVE SOLUTIONS

We work with a flexible approach focused on the client’ problem areas and develop customized solutions to address them. We build relationships because we know that working together is critical to our success as a business partner for our clients.

EXPERTISE

To continuously provide high standards of service our team is comprised of only highly experienced clinicians who are proficient in ensuring the highest quality of support.

Affordable

We offer a proven, reliable and affordable medicare-compliant avenue of support, so that you can continue to focus on providing high-quality services to your clients, all while optimizing operational costs.

Quality Emphasis

We have multilevel QA process to minimize  errors and maximize accuracy in the reports  we provide. Medical reviews are quality  checked on a daily basis with clear  internal processes in place to address any concerns.

CLINICAL COMPLIANCE REVIEW

Home Health

We only employ registered nurses with a master’s degree to perform chart reviews.

At the Start of Care, we review the Face-to-Face Encounter to confirm timely completion by an appropriate provider and that the Face-to-Face Encounter supports homebound status and skilled need.

As this requirement is critical for certification of eligibility for Medicare home health services, this step at the time of start of care ensures that your agency’s compliance to the Conditions of Participation improves significantly. 

Our Pre-Bill Reviews focus on reviewing  support for the Face to Face (F2F), eligibility, plans of treatment, interim orders, visit documentation, and medical necessity to verify that all required information for billing is present and in accordance with Medicare coverage criteria and billing guidelines.

On a monthly/quarterly basis, we will summarize our statistical findings of the reviewed charts. We will provide analysis of the reviews at a provider, clinician, clinical manager, and physician level. This report will highlight trends impacting the organization and enable multi-level analysis of the identified issues.

For providers under Review Choice Demonstration, we do the pre claim reviews of the documentation to determine if beneficiaries meet home health coverage requirements, package the charts based on the tasks and submit it to the Medicare Administrative Contractor (MAC).

The agencies we are working with have been able to keep the affirmation rate above 95%, much higher than the required 90%.

Hospice Review

Our hospice reviewers assess your clinical documentation to determine the appropriateness of hospice services. We review a sample of your records and provide a summary report describing whether the records contain all the specific documentation and information required by CMS. Reviews can be customized to assess any areas that you require including Start of Care Reviews, Recertifications Reviews and Level of Care Documentation reviews. Our reviews provide you with valuable feedback on the support and training that your clinicians and providers need to improve compliance

“The Red Road consulting team is committed to quality assurance and excellence. Red Road utilizes a team of experts who focus on the careful review of clinical documentation to assure necessary regulatory criteria are met and the record reflects quality patient care services. The Red Road reviewers provide prompt service with timely feedback and maintain a close working relationship with our quality assurance team.”

Ami Sparano
Chief Compliance Officer - VNA Health Group