Weatherbee assists hospices with Targeted Probe and Educate (TPE) submissions, appeals, and education to identify and mitigate risk exposure. 

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Services

 

TPE & Appeals consultations may include:

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• Analyzing census statistics to determine case mix and identify potential risk areas

• Evaluating forms to ensure that they are technically valid

• Reviewing clinical records to determine whether:

  • ​Administrative requirements are met

  • Physician and interdisciplinary documentation demonstrates medical necessity and eligibility for care, including higher levels of care

  • There are any documentation-related opportunities for improvement

• Writing independent expert cover letters summarizing patient eligibility, or drafting summary cover letters for staff to review and submit with the ADR or appeal

• Evaluating internal systems and processes to ensure that they support proper billing

• Developing an ADR tracking system

• Presenting recommendations to mitigate future risks

• Assisting with the appeals process, including preparation for testifying before Administrative Law Judges

• Providing expert witness testimony

• Developing and facilitating customized education in responses to identified issues

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Outcomes

 

The primary goal of every Weatherbee consultation is to identify and reduce or eliminate risk exposure.

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Engaging Weatherbee will result in:

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• Assuring the validity of your hospice's documentation tools and forms;

• Increasing the likelihood of successful payment of ADRs and appeals;

• Ensuring that systems and processes identify billing-related issues prior to releasing claims; and,

• Enhancing interdisciplinary competence with regard to discerning, documenting, and defending hospice eligibility.

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Please contact Weatherbee for additional information regarding how we can help you with ADRs and the appeals process.

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