Recovery Audit Management Services

In today's clinical and regulatory healthcare environment, protecting earned revenue has become almost more important than ensuring future billings. Healthcare providers can find themselves in the center of up to a 3-year claw back with recoupment responsibilities. Improper or inaccurate overbilling due to "Lack of Medical Necessity" or "Non-Sufficient Documentation" along with higher utilization compared to neighboring providers are all audit triggers that need to be addressed.

Pre-Recovery Audit
Services (click for more)

Post Recovery Audit Response & Appeal Defense (click for more)

Physician & Staff
Training, Education
and Support (click for more)

What is your Protocol if or when your organization is notified of an upcoming Recovery Audit? SHA will assess your existing facility/surgical practice recovery audit procedures and will co-author and co-coordinate a compliant corporate recovery audit protocol that will have you fully prepared. Our proactive measures will leave your organization primed and ready to deal with the rigors of the time consuming and potentially catastrophic recovery audits.
Based on RAC, ZPIC & OIG target intelligence & proprietary know hows, SHA will perform mock audits and evaluate your most vulnerable DRG assignments and medical necessity documentation. SHA routinely offers coding accuracy audits to help reduce recoupment findings and improve your bottom line.

A solid internal audit and compliance program starts with using Medicare coverage criteria as your foundation, along with our Medicare self-audit templates. Our master templates can be customized and are perfect for use by internal auditors and compliance professionals when reviewing potential Medicare focus areas and building winning Medicare appeals. Customized letterhead or standard detailed self-audit templates are available for purchase throughout the United States.

Sometimes appealing claims that lack the necessary documentation have billing or coding errors, inappropriate CPC's, contain the incorrect number of units billed, or fail to report manufacturer credits for replaced medical devices, simply do not make sense to appeal. SHA's internal compliance and coding experts will assist you.

SHA can augment your existing EHR system with protocols to ensure on-going recovery audit timeliness and spot on accuracy. Let our proprietary work flow process guide you through initial submission, adverse findings and the appeal process.

Education never ends because compliant coding and reimbursement is a moving target. SHA can provide on-site and up to date coding presentations tailored to your specific needs. The entire surgical team including physicians, pratical staff and facility personnel need the latest information and current coding nuances that payors require for correct claim submission and final reimbursement. Our experienced educators can create a curriculum and interactive sessions to put you ahead of the curve.

If on-site education is not ideal for your practice or group, SHA can provide personalized physicians curriculum and education through Webinars.

SHA professionals provide reimbursement, coding and coverage presentations that address current "hot topics" or teaches groups "RAC Response 101", as well as anything in between. We can deliver the CEU for member associations and affiliated groups, with topic specific accuracy and interactive learning environments.