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EHR Solutions

Denials and Appeals Management

     • Pre-Appeal Review
     • RAC, MAC, MIC Appeals Management
     • National Coverage Determination (NCD) Denials

EHR has extensive experience with all stages of the governmental payer appeals process and have achieved unmatched success in identifying and obtaining the reversal of thousands of inappropriate RAC, MAC, MIC, and QIO medical necessity denials at all levels of appeal. EHR's methodology combines expert physician clinical expertise, focused on medical necessity, with regulatory arguments so all appeal avenues are explored.

EHR has managed more than 500,000 Medicare appeals on behalf of hospitals across the country. In most cases, EHR manages the entire appeals process through all levels of appeal, including preparing briefs and presenting evidence to Administrative Law Judges (ALJ), a level at which EHR has experienced tremendous success.

EHR's in-depth understanding of the Social Security Act, Code of Federal Regulation and CMS Manual and Ruling guidance results in superior appeal outcomes and allows for a coordinated process with its clients' case management, compliance, and legal departments.

Contact EHR to learn more about its Denials and Appeals Management solutions.

EHR Logic™

Medical Necessity Compliance Management

AccURate™ - Commercial Admission Review

Denials and Appeals Management

Managed Care Denials Management

Physician Documentation Services

Specialty Services

EHR Compliance Library

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