Welcome to Coastal Home Health Solutions an innovative and exciting
Home Health Care Consulting company founded and ran by registered nurses with extensive home health care experience to meet all of your needs in the home health field. We are experts in pre/post edits,
and preparing Medicare appeals at all levels.
We are also available to attorneys to review medical charts
Home Health Care and Hospice
Provider Services include;
Chart Audit Preparation
ADR Response Preparation
Compliance and Risk
RACs, MACs and ZPIC Audit & Appeals Management
Home health care is changing and having to adapt to the ever increasing competitive market out there. It has also been hard hit by the Government in an attempt to curb
Medicare fraud. In response to losing billions of dollars each year due to fraud, abuse and wasteful practices such as over utilization of services,
Medicare has developed programs such as Recovery Audit Contractors (RAC) to search for overpayments and underpayments. In order to do this the RAC companies shall post- audit charts, audit providers, identify improper payments and claim reviews. The RACs are private companies and are paid on a contingency fee. Basically, the more charts they deny the more money they get for themselves. They are very well motivated to find mistakes or over utilization of services. According to ACHI spokeswoman Becky Reeves on
February 20th 2014 that " The RAC program recovers more than $1 billion per quarter while only reviewing 2% of medical records. That is a shocking percentage and should strike fear into the hearts of all
There is also the Medicare Administrative Contractors (MAC) to deal with and again they are private contractors. The MACs conduct prepayment audits and will deny payment if they so choose. They, like the RAC entities work on a contingency basis.
Then there is Zone Program Integrity Contractors (ZPIC). ZPIC can, and will initiate an investigation against you if it is suspected fraud has taken place. They will then turn you over to the Department of Justice and/or the Office of Inspector General to be investigated. It is imperative when dealing with a ZPIC request for documentation that suppliers immediately address the targeted audit issues using strategic planning.
Coastal Home Health Solutions is very experienced in dealing with
ZPIC audits and
100% pre-payment reviews. Let us
prepare your ADR requests, deal with the RACs, MACs and ZPIC. Our success rate in dealing with all the aforementioned is upward of 90%. We are affordable, reliable and will fight hard to keep the money you rightfully earned.