The Provider's #1 Resource - Medicare PSC Audits & PSC Appeals
Medicare PSC Appeals & Legal Services / PSC Clinical & Compliance Reviews / Medicare Fraud & Abuse
Contact Us For Immediate Assistance - (303) 586-5003 or support@pscaudits.com
Castle Rock Medical Group To speak with our experienced Medicare consultants, clinical auditors or Medicare lawyers - or for questions regarding Medicare PSC audits consulting, PSC appeals or PSC legal services - please contact us directly at (303) 586-5003 or support@pscaudits.com.
Medicare Program Safeguard Contractor Consulting & Legal Services
Helping Providers Insure CMS Compliance & Benefits Integrity
PSC Audits & PSC Appeals - Clinical & Compliance Reviews
Castle Rock Medical Group (a Jackson Davis Healthcare company) is the nation's leading advisor to physicians, hospitals and physical therapists facing Medicare PSC audits and PSC appeals. Ranging in size from major multi-specialty group practices to individual physicians and physical therapists to academic medical centers and critical access hospitals - CRMG's Program Safeguard Contractor (PSC) audit clients are at the forefront of insuring compliance with CMS payment criteria and medical necessity requirements.
CRMG is the leading national resource for PSC medical reviews and assessments, payment criteria documentation, billing compliance, appeals & legal advisory services. Comprised of board-certified physicians, nurses, billing compliance professionals and former hospital executives - we are widely recognized as the nation's leading expert on Medicare PSC audits and Medicare PSC appeals. Although the PSC 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 compliance with CMS payment criteria and medical necessity requirements.
Castle Rock Medical Group is a wholly owned subsidiary of Jackson Davis HealthCare. With over 300 physician, hospital & health system clients across the U.S. and internationally, Jackson Davis HealthCare is widely recognized as a national leader in Medicare compliance, Medicare fraud and legal services.
CMS is aggressively pursuing perceived overpayments and potential fraud implications through Medicare PSC audits, Medicare ZPIC audits, Medicare RAC audits and Medicaid Integrity Contractor (MIC) audits in order to advance and solidify evidence-based medicine as the foundation for the future of the Medicare program. CRMG professionals work with physician practices, hospitals, inpatient rehabilitation facilities, physical therapists and health law firms nationwide in a wide range of Medicare PSC consulting focus areas:
Medicare PSC Audit Medical Record Reviews - Physician Services
Medicare PSC Audit Medical Record Reviews - Physical Therapy Services
Medicare PSC Audit Appeals
PSC Clinical Documentation & Coding Compliance Management
PSC Audit Legal Services & Fraud Defense
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.
Medicare PSC Audits - Clinical Documentation & Medical Record Reviews
CRMG's Medicare PSC audit clinical & billing assessments (or "Mock Audits") are centered on CMS payment criteria and Conditions of Participation documentation and traditionally include a pre-determined sampling of 20 - 100 patient visits. Each patient visit is pre-screened and carefully selected based upon the PSCs primary focus areas and the physician practice or physical medicine specialty profile (i.e. Cardiology, Vascular, Ortho, Oncology, etc.).
Based upon the number of records being reviewed and scope of the PSC audit focus areas, CRMG's Medicare PSC Audit assessments are traditionally completed over a 2 - 8 week time frame.
Each in-depth evaluation incorporates a stratified sampling of Medicare PSC audit focus areas and includes 3 major assessment components - billing, coding structure & medical necessity. All CRMG PSC audit & PSC appeals services include detailed evaluations by our board-certified physicians, nurses, case management specialists, legal services staff, Medicare reimbursement and billing compliance professionals.
CRMG experienced Program Safeguard Contractor (PSC) audit consulting professionals, PSC appeals attorneys, physician & nursing staff 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.