(925) 381-2085

Quality Management

Each claim submitted to CMS has a potential for error and can result in improper payment or recoupment opportunities; therefore, preparedness, timeliness, and accuracy are essential when auditing charges prior to billing, responding to government demand letters and appealing overpayment charges.

The team at RRCS, Inc. can help your organization prevent Medicare and Medicaid denials, manage appeals, and significantly decrease the organization’s deficit variance due to denied claims. Our solutions provide a hands-on approach with operational support and high flexibility to recapture lost revenue.

Our auditing and appeals services include:

  • Coordinating and directing all Medicare/Medicaid appeals and denials
  • Developing successful response strategies to overpayment demand letters
  • Providing mock audits and internal data mining analysis to pinpoint errors before bills are sent out
  • Conducting organization-wide education on the appeals process, the Medicare/Medicaid recovery program, audit preparedness, and relevant and current laws and regulations
  • Implementing quality improvement processes to minimize impact of future recovery audits
  • Implementing, managing or serving as the organization’s recovery audit team and/or coordinator

Our services aim to decrease customers’ overpayments, increase appeal success rates and implement an appeals management standard work process utilizing a quality improvement approach.