Our Solutions

Consulting

R1 PAS Clinical Solutions provides a broad range of consulting services including assessment of case management department operations, review of regulatory compliance, assessment of physician documentation, probe audits, review of revenue cycle functionality and efficiency, and evaluation of the hospital's denials management process.

Appeals and Denials

R1 PAS Clinical Solutions has had outstanding success in appealing RAC, MAC, and other Medicare audit denials of hospital billing. Our success rate in overturning denials of billing based on our recommendations is greater than 95%. We offer commercial appeals within the parameters of the hospital's contracts. The first step in the appeal process is to determine whether the physician's documentation is strong enough to support an appeal. We will advise a client if in our judgment a case is not appealable. For any government payor case on which our billing recommendation was followed, we status assure by providing no-cost appeal of any denials at the first two levels with a small charge for appeals to the Administrative Law Judges and above.

Admission Status Review

The assignment of patients to inpatient or outpatient status (with or without observation) is based on complex and ambiguous Medicare regulations. This distinction drives all of hospital billing, yet is fraught with errors. R1 PAS Clinical Solutions employs physicians and trains them on the ins and outs of the regulations so they can assist the treating physicians to correctly categorize patients for billing status utilizing a user-friendly web portal and remote access to the hospital's electronic medical record. We provide support for hospitals with payers which are using the two midnight rule and those that are using traditional medical necessity definitions and criteria.

Physician Education

R1 PAS Clinical Solutions prize itself on its nationally recognized physician education program. Utilizing webinars and on-site presentations, our physician content specialists design an education program to meet a hospital's needs, from one-on-one education to grand rounds presentations to full day seminars. The focus of physician education can be determined by a hospital's own data including billing status conversions resulting from physician advisor recommendations (inpatient to outpatient or outpatient to inpatient) or the hospital's record of denials and appeals.

Transcription

R1 PAS Clinical Solutions can meet a hospital's transcription needs through a cost-effective transcription service that utilizes the most advanced voice recognition software while providing rapid turnaround times, extreme accuracy, and total HIPAA compliance.

Payor Peer To Peer (PPTP)

Payor Peer-to-Peer (PPTP) Review is a concurrent denials management service provided by R1PAS in which our experienced physician advisors discuss the denial real time with the payor on the hospital’s behalf when the authorization is not granted. Case entry into our secure web based portal is simple and efficient way to track concurrent denials.

As part of the PPTP Review process the following standard steps will occur:

  1. R1PAS physicians will review all pertinent patient medical records in real time
  2. R1PAS physicians will coordinate and participate in calls with payor medical directors who denied authorizations/medical necessity of the patient’s stay.
  3. The R1 system automatically informs the hospital’s case manager of all pertinent aspects of the PPTP including when the insurance company was contacted, who the review was with, and the final outcome.
  4. Reporting on these results will be made available to help analyze payor behavior that supports your Managed Care team

R1PAS Physician Advisors are trained to recognize the clinical nuances between inpatient and outpatient care. This training allows PAS Physicians to support the hospital’s physicians’ admission orders by having a deep understanding of the payor screening process, as well as, the complex medical judgment criteria used by the payors. This service allows the hospital’s physicians to focus on the patient, while still protecting your revenue and proactively preventing denials.

 

Remote Utilization Review

Utilization management and appropriate admission status are major compliance issues and audit risk for hospitals today.   R1 RCM’s highly trained, experienced Utilization Review Specialist (UR Nurses) offer remote, concurrent and retrospective level one (Nurse Review) screening of a single episode of care.  We offer a customizable approach that  can fit your needs for consistent utilization review in order to comply with Medicare’s condition of participation and to identify cases at risk for denial across all payors. Our web based portal offers   ease of case selection and transmission processes.   We offer coverage either as support to existing staff or for non standard care management hours ( nights, weekends, holidays).  We can supplement your staff so that they can prioritize their day without worry of missing cases as they work on the myriad other  duties of hospital case management.

Our nurses are trained in multiple criteria sets and can support your department regardless of what criteria set your facility uses in their day to day review.  In the event that the  review outcome indicates that the ordered level of care is not validated by the criteria second level review with R1PAS physicians can be obtained seamlessly if authorized by the client.

We offer a cost-effective mechanism to provide appropriate utilization review for non-standard hours of Case Management to ensure continuity of process.  Our hours of operation are: 8am – 12 am CST, 7 days a week, including holidays.


Contact Us

For questions or help with using any of the tools available on this workbench, please contact R1 Support using the following methods:

Physician Advisory Services Support

Phone

Support:(877) 411-5531

Email

LOC/PPTP/CSR Support:passupport@r1rcm.com
PAS Appeals Support :appeals@r1rcm.com

Fax

LOC Fax:(855) 5-PASLOC (855-572-7562)
FLR Fax:(855) 572-7778
PPTP Fax:(855) 572-7562
Appeals Fax:(855) 572-7332