The Healthcare Provider's #1 Medicare Compliance Resource
Medicare Audit & Compliance Tools - Medicare Appeals - CMS Program Integrity Resources
To report Medicare fraud, please contact the Office of Inspector General at (800) 447-8477 or HHSTips@oig.hhs.gov
Medicare Audit & Compliance Tools - Medicare Appeals - CMS Program Integrity Resources
To report Medicare fraud, please contact the Office of Inspector General at (800) 447-8477 or HHSTips@oig.hhs.gov
Jackson Davis HealthCare (formerly the Castle Rock Medical Group) offers healthcare providers the nation's leading solutions for Medicare fraud prevention - resources, knowledge, tools & technology. Jackson Davis is the one of the nation's leading providers of Medicare clinical compliance & Medicare fraud support services, Medicare appeals, CMS audit tools, CMS continuing education resources and CMS reference documentation for healthcare providers, health plans, health law firms, healthcare consulting organizations and Medicare beneficiaries.
Jackson Davis HealthCare is the nation's leading advisor to hospitals, physicians, inpatient rehabilitation facilities, DME suppliers and physical therapists facing Medicare audits, Medicaid audits and potential Medicare fraud issues. Ranging in size from $8.0B major academic medical centers to individual physicians to DME suppliers and $25M critical access hospitals - our exceptional Medicare & Medicaid audit clients are at the forefront of insuring compliance with CMS Payment Criteria and medical necessity requirements.
Comprised of board-certified physicians, nurses, billing compliance professionals and former hospital executives - we are widely recognized as a leading expert on CMS efforts to stop Medicare fraud, Medicare audits and Medicare appeals. Although Medicare or Medicaid audit target issues may vary based upon a physician's specialty or hospital's reimbursement structure, CMS Payment Criteria are applicable across the spectrum. We absolutely and unconditionally guarantee that our clients are at the forefront of insuring Medicare & Medicaid compliance.
CMS is aggressively pursuing perceived overpayments and potential fraud implications through Medicare PSC audits, Medicare ZPIC audits, Medicare RAC audits and Medicaid Integrity Contractor audits (MIC audits) in order to advance and solidify evidence-based medicine as the foundation for the future of the Medicare and Medicaid programs. Jackson Davis HealthCare professionals work with hospitals, physicians, inpatient rehabilitation facilities, physical therapists, DME suppliers, health plans and health law firms nationwide in a wide range of CMS focus areas:
Medicare & Medicaid Clinical Reviews - CMS Payment Criteria
Medicare Appeals & Medicaid Appeals
CMS Clinical Documentation & Coding Compliance Management
CMS Audit Legal Services, Medicare Fraud & Medicaid Fraud Defense
Medicare Concurrent Compliance Review
CMS Criteria-Based Documentation & Medicare Self-Audit Tools
Case Management / Utilization Review / Discharge Planning
Charge Master and Medicare Cost Report Compliance
RAC Audits - RAC Appeals - ZPIC Audits - ZPIC Appeals - MIC Audits - MIC Appeals
The nation's #1 resource for CMS compliance self-audit tools & documentation
Hospitals, physicians and other healthcare providers are facing the imminent adoption of Medicare's new evidence-based reimbursement structure, implementation of wide ranging EBM policies & procedures and the introduction of concepts such as evidence-based coverage, pay-for-performance and value-based purchasing. In order to insure compliance and make a clean break from the past, CMS is using high-profile audits to force the implementation of evidence-based standard of care practices.
Claims and opinions of CMS audits being based in subjectivity and vague interpretations of Conditions of Participation requirements or medical necessity couldn't be farther from the truth. Outdated notions and concepts of "soft" Medicare billing, documentation and claims submission requirements have been left in the past. The game has changed - very real and defined CMS Payment Criteria, required documentation and the application of CMS evidence-based outcomes rule-the-day.
Jackson Davis HealthCare (formerly the Castle Rock Medical Group) works closely with providers nationwide to perform Medicare and Medicaid criteria-based case reviews. These CMS criteria-based case reviews are essentially designed as CMS "mock audits" that are centered on CMS payment criteria and Conditions of Participation documentation. Traditionally, these case reviews include a pre-determined sampling of 25 - 500 patient encounters with each patient encounter being pre-screened and carefully selected based upon the CMS primary focus area.
CMS Audit Support - Clinical Documentation & Medical Record Reviews
Based upon the number of records being reviewed and scope of the CMS audit focus areas, Jackson Davis HealthCare staff typically complete Medicare or Medicaid criteria-based case reviews over a 2 - 8 week time frame.
Each in-depth evaluation incorporates a stratified sampling of Medicare or Medicaid audit focus areas and includes 4 major assessment components - documentation, billing, coding structure & medical necessity. All Jackson Davis HealthCare audit & appeals services may include detailed evaluations by our board-certified physicians, nurses, case management specialists, legal services staff, CMS reimbursement and billing compliance professionals.
Our experienced Medicare and Medicaid compliance professionals, clinical documentaiton auditors, legal support staff, physicians, nurses and former hospital executives are all dedicated to providing you with an unmatched professional services experience. Each assessment finding is supported by an extensive & wide range of formal documentation resources authored by or reviewed on behalf of the Centers for Medicare & Medicaid Services (CMS).
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CMS Audits & CMS Appeals - 100% Unconditional Compliance Guarantee
Jackson Davis HealthCare absolutely and unconditionally guarantees enhanced Medicare & Medicaid compliance by our clients. As a leader in providing of CMS audits & CMS appeals professional services, legal support, CMS reference documentation, self-audit tools & continuing education (RAC audits, PSC audits, ZPIC audits & MIC audits) - we guarantee our work.
If Jackson Davis HealthCare (formerly the Castle Rock Medical Group) provides formal guidance, consulting or legal services relating to CMS payment criteria – and our client adheres to formal CMS guidance – Jackson Davis will defend the provider at no additional cost throughout the first 4 levels of the Medicare appeals process including – Rebuttal, Redetermination, Reconsideration and the Administrative Law Judge hearing.
This Unconditional Compliance Guarantee is offered for clients under professional services contracts for CMS clinical reviews & assessments, Medicare audits, Medicaid audits, Medicare appeals and a wide range of similar compliance services.
For questions regarding CMS efforts to stop Medicare fraud & abuse, Medicare audits, Medicare appeals, RAC audits, ZPIC audits, MIC audits, CMS auditing tools, CMS reference documentation, CMS PI Warehouse or other Medicare legal support services, please contact us directly at (303) 586-5003 or support@stopmedicarefraud.com.