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/JDs on staff with years of specialized clinical experience for medical necessity reviews.

The following are examples of medical necessity cases:

  • Inappropriate admissions
  • Inappropriate tests
  • PA/MD issues

A unique feature of our compliance services is that Prospective Payment Specialists has formally retained a national law firm with substantial 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.