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Our Services
Medicare Part A Utilization Review
Review with a professional Medicare Consultant on a weekly and as needed basis regarding your Medicare Part A skilled or Swing Bed patients. We can help answer questions related to admitting a skilled Medicare patient, extended stay reviews, RUG IV criteria, and MDS guidelines. We are guaranteed to provide friendly, immediate answers to your important Medicare questions.
MRC’s consultants work one-on-one with your staff to assist in determining the appropriate level of care per individual patient and circumstance. Weekly review with the facility will be initiated by a consultant at MRC, and conducted with the DON or other knowledgeable personnel. During this weekly review, we will discuss each skilled Medicare patient and determine if they are still meeting skilled care criteria. If questions arise about admitting or discharging a skilled patient, staff in the facility are encouraged to call MRC where a consultant will be there to quickly answer your questions. MRC consultants will generate an abstract regarding the progress of the patient, which will be sent to the facility upon the patient’s discharge from skilled care.
Physician Peer Review
MRC contracts with two highly experienced physicians in the fields of General Practice and Internal Medicine to provide competent, knowledgeable reviews of physician treatments and charting. Our physicians have over 25 years’ experience each in their respected fields, and are still treating patients on a daily basis. Our physicians help to provide unbiased, professional opinions of patient treatment and plan of care to those requesting our services. Critical Access Hospitals and Rural facilities extensively use this service to prevent their physicians from having to review a colleague’s work.
RAC Appeals Assistance
Let our experienced consultants help you to navigate your RAC appeal. A RAC appeal can be a confusing, time-demanding, and expensive process for you and your facility. There are two basic approaches for the provider in justifying appeal of an adverse RAC determination: identify why the underlying claim is meritorious, and/or identify and explain any legal defenses to the RAC’s adverse determination. We can help you with an initial analysis of prospective success of an appeal and navigate the complex requirements of this appeals process if that is the chosen path.
