Jackson Davis Healthcare, Inc.
UPIC Appeals | UPIC Audit Help | 10,000+ Winning Medicare & Medicaid Appeals
Get UPIC audit help from the nation's #1 UPIC audit defense team!
UPIC Audit Defense | TPE Audit Defense | RAC Audit Defense | Settlement Conference Facilitation
Over the past 25 years, Jackson Davis professionals have been called on to support 1,000s of healthcare providers and healthcare legal counsel from coast-to-coast. We've been asked to handle a full range of CMS audit defense support including day-to-day management & administration of all audit / appeals functions, meeting with USAO staff and CMS auditors, presenting audit results & outcomes to executives and board members, in-servicing staff & physicians, offering expert testimony in a wide variety of setting, etc. We can provide expert testimony and/or representation at ALJ hearing and settlement conferences for a full range of the most complex UPIC appeals, TPE appeals or RAC appeals cases. Our independent & experienced board-certified physicians, legal nurses and/or compliance staff can offer expert testimony for UPIC audit defense at the federal judiciary level. Just ask and we will help in anyway possible!
Transaction Due Diligence Audits
In today's complex UPIC audit environment, purchasing the assets and accepting the liabilities of any healthcare provider can be risky. Jackson Davis is trusted by some of the nation's largest health systems and we have completed due diligence evaluations associated with the purchase of $1.0B+ health systems, community hospitals and multi-specialty physician practices. We can help you identify the primary areas for concern - perform detailed coverage criteria audits and physician reviews - quantify potential losses and then assist with the implementation of compliance enhancing solutions.
CMS Compliance Services
Providers nationwide trust Jackson Davis to help with independent CMS compliance evaluations, clinical documentation improvement, Medicare & Medicaid audit education, Medicare & Medicaid internal audits, transaction due diligence, CMS compliance advice or professional guidance on a project-by-project basis.
Our staff is highly experienced and our knowledge and application of Medicare & Medicaid rules and regulations is unmatched in the industry. No one on our professional staff has less than 10 years of hands-on, healthcare operational and/or clinical experience. We are true CMS compliance geeks. From our board-certified physicians to our nurses to our compliance research team, we are in your corner and available 24/7 for your CMS compliance needs. Hospital appeals, physician appeals, SNF appeals, home health appeals, hospice appeals, IRF appeals, ambulance appeals and HME supplier appeals - call us today and put Jackson Davis to work for you!
RESTORE Profitability Enhancement & Stability Services
"No money, no mission"... the oldest and truest phrase for any healthcare provider dedicated to providing the highest quality of care to their patients. So, how do we combine zero-risk, UPIC audit compliance solutions with insuring bottom-line performance? Jackson Davis professionals have assisted providers nationwide in increasing bottom-line performance by over $250M, while recouping over $150M in Medicare & Medicaid denials. How? We lead with fully compliant, technology-driven solutions and wholly integrate those into improvements in both Revenue Cycle & Hospital-Wide Operational processes. This is a value-based service and we are solely paid on implemented alternatives and actual bottom-line performance outcomes. Call us today - we CAN help defend against UPIC audits and improve your bottom-line!
UPIC Appeals | TPE Appeals | RAC Appeals
Over the past 30 years, Jackson Davis Healthcare professionals have worked with providers nationwide to appeal 10,000+ of Medicare & Medicaid overpayment issues. Jackson Davis partners with providers to analyze, develop & build winning UPIC appeals, TPE appeals and RAC appeals cases. Our board-certified physicians, legal nurse auditors and industry-leading compliance staff are unmatched in Medicare & Medicaid audit defense and the submission of winning Medicare & Medicaid appeals. Simply put, NO ONE will give you a better chance to succeed at defending against CMS audits.
From initial receipt of an ADR or targeted probe & education letter... to preparing redetermination / reconsideration submissions... to providing expert testimony at ALJ hearings... to full representation & expert testimony at settlement conferences.... to pretrial preparation and a full range of expert audit & clinical compliance support at the federal judicial level... we are in your corner!
Just a small sample of our 10,000+ Medicare & Medicaid appeals over the past 25 years includes:
Jackson Davis HealthCare, Inc. is the nation's #1 resource for building winning Medicare & Medicaid appeals cases. Over the past 25 years, we have worked side-by-side with some of the nation's best healthcare providers to build rock-solid cases and defend against UPIC audits, TPE audits, RAC audits, ZPIC audits, OIG audits, USAO audits and other governmental entities. We have assisted 100s of providers coast-to-coast in building winning CMS appeals for 10,000+ Medicare and Medicaid cases.
As the provider's unwavering advocate, we can assist in building every aspect of your UPIC audit, TPE audit or RAC audit defense strategy. Defending against Medicare or Medicaid audit recoupment, challenging CMS audit extrapolations, responding to potential CMS fraud allegations and insuring ongoing CMS compliance are all critical outcomes of the process. Using Medicare & Medicaid coverage criteria as the foundation, our professionals are wholly dedicated to defending providers facing the stress, anxiety and financial challenges related to UPIC audits, TPE audits or RAC audits. Our professionals dedicate every day to understanding, documenting, synthesizing and applying national Medicare coverage criteria and state-by-state Medicaid criteria to cases conditionally denied by CMS auditors.
Hospitals | Hospice | Home Health | SNF | IRF | Physicians | Cardiac Cath. Lab | Ambulance | Wound Care | DME
Call Today! (303) 586-5003 firstname.lastname@example.org
HOSPITALS - Major joint replacement (hips & knees), diagnostic laboratory testing, emergency room visit criteria, MS-DRG/Modifier/CPT selection, PCI / ICD / pacemakers (surgical procedures in wrong setting or short-stays), one-day stays (chest pain, heart failure, syncope, pneumonia, etc.), excisional debridement, admission orders, extensive O.R. procedures unrelated to PDX, lumbar spinal fusion, septicemia diagnosis code sequencing
HOSPICE (Part A & GIP) - Admissions, medical necessity, certifications, F2F clinical coverage criteria, lack of documentation... [numerous cases where patients received hospice care for 2+ years]
HOME HEALTH- Admissions, certification, F2F, homebound status, skilled nursing, therapy, medical necessity, OASIS validation
IRF- Admissions, medical necessity, documentation, therapy
SNF (Part A & B) - Admissions, MDS challenges, therapy, documentation, medical necessity
PHYSICIANS - Part A & Part B xover claims, facet joint injections, modifier 25, diagnostic testing, AWV, E&M coding (inpatient & office visits)
CCL - Wide range of diagnostic cath. and revascularization procedures