Medicare Appeals/Denials

Theracore assists numerous clients with Medicare appeals and denials management of Medicare claims. For Clients currently in a pre or post payment Probe Review by their Medicare Administrative Contractor (MAC) or undergoing a RAC audit, Theracore can manage all aspects of the Medicare Appeals process from the initial Additional Development Request (ADRs) through the three levels of the Appeals Process when the client disagrees with Medicare’s decision to deny or rescind payment for the claim(s) under review. Their approach and methods significantly improve a facility’s chances for a favorable response from Medicare in response to ADRs and denials. They also develop ad provide a Denials Management Timeline Tracking Tool to assist clients in managing the timely filing at each level of appeal. Throughout the appeals process, they train and implement documentation strategies to decrease the risk of future Medicare review and denials.

At any level of appeal Theracore thoroughly reviews the medical record and creates an appeal letter that is submitted along with the appeal request. This letter includes a summation of the resident’s clinical status and highlights aspects of the documentation that supports that the services provided were reasonable, medically necessary and skilled according to Medicare requirements. Theracore has an unprecedented success rate of 90% turnover with favorable decisions at the Redetermination Level for claims determined to appealable.