Health care reform is having a significant impact on reimbursement and compliance issues for health care organizations. New rules are significantly stricter and reflect the government’s commitment to proactively fighting fraud, waste, and abuse. The period for reporting overpayments has decreased to 60 days and the threat of penalties has increased for non-compliance. Regulatory paperwork has also increased. Simple errors can amount to major headaches and a loss of revenue when providers are already struggling to manage from payment to payment.

PBSI knows exactly how claims are processed and reviewed and how reimbursements are calculated and audited. We know what federal agencies expect and can ensure your documentation is correct, accurate, and acceptable to support your claims submissions and satisfy auditors. We provide training and advisement so your organization can confidently manage the claims and reimbursement processes, including efficient and effective responses to demands for overpayments resulting from external reviews.

PBSI has decades of experience working with government agencies and with providers. We understand the complexities of claims and reimbursement compliance and can help clients navigate them using two approaches:

Assessment: We evaluate the current state of reimbursement and claims compliance. We can provide claims and cost report preparation, audits and analyses, and management of additional documentation requirements and requests.

Improvement: PBSI can strengthen existing processes and documentation for claims and reimbursement through robust analysis and training. We can assist you in achieving consistent, positive results for reimbursement and claims through appropriate interpretation of and response to policy and guidelines, however vague or complex.

Contact us for more information on how we can customize our Claims and Reimbursement Review services to support your specific needs.