| PPS will assess the appropriateness of medical
necessity as documented in the medical record
and will submit opinions on compliance with
coding and billing requirements associated
with a physician’s professional services,
inpatient admissions and ancillary orders.
PPS has on staff MD/JD’s with years of specialized
clinical experience for medical necessity reviews.
The follow are examples of medical necessity cases: inappropriate admissions,
inappropriate tests, and PA/MD issues.
A unique feature of our compliance services is that Prospective Payment Specialists
has formally retained a national law firm with substantial
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experience in the False Claims Act as it pertains to healthcare and hospital providers.
What appealed most to PPS was that, more than any other major law firm, the partners
and associates in the healthcare division have specialized in compliance law for
hospitals. Many of them have spent prior years prosecuting these types of cases
for the Department of Justice.
We perform our compliance programs with their guidance, thereby providing our
clients with not only precisely specialized coding and reimbursement
expertise, but also unparalleled preparation and a
detailed understanding of crucial compliance issues.
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