Synchrony Rehab Helps You Navigate through Appeals

There are many attributes that make Synchrony Rehab stand out.  Strong documentation standards that result in timely and effective reimbursement for quality rehab services provided is definitely one.  We pride ourself on holding clinicians to a high standard to provide supportive documentation to ensure Medicare and other payor standards are met. Synchrony Rehab utilizes a strong Clinical Support team of therapists from all three rehab disciplines who work closely with our customers to ensure timely and thorough submission of appeals are completed.

Documentation is a crucial part of winning an appeal.  Our Clinical Support Team, with the aid of the Area Managers, routinely audit documentation and provide ongoing education to therapy staff and in-services to nursing to ensure the skilled treatment being provided is clearly defined.  Synchrony Rehab interacts with other professional organizations in the industry to keep pace with current appeal trends.  This includes involvement in a collaborative national group that discusses MAC updates along with other recent CMS and Managed Care regulatory requirements.  Collaboration with our peers on a national level allows us to train our team of therapists on the latest industry updates to ensure integrity of our coding and billing.

When a CMS or managed care audit does take place, Synchrony Rehab is prepared to assist customers navigate through the appeal levels to obtain payment for skilled services provided.  Synchrony Rehab has experience with the ADR process and works closely with our customers through the first four level of appeals.  Our commitment to excellence makes us a strong partner to ensure the quality services provided are recognized.  Synchrony Rehab consistently maintains a greater than 94% overturn rate of denied claims.    

Breakdown of the Appeals Process:

  • An additional development request or ADR may be generated to request documentation from a provider to assist with adjudicating a Medicare claim.  There can be two different types.
    • Medical
    • Non-medical
  • If the documentation requested during and ADR is found unfavorable, it may lead to the initiation of the appeals process.
  1. First level of appeal: Redetermination by a Medicare Contractor.
  2. Second level of appeal: Reconsideration by a Qualified Independent Contractor
  3. Third level of appeal: Decision by Office of Medicare Hearing and Appeals (OMHA)
  4. Fourth level of appeal: Review by the Medicare Appeals Council
  5. Fifth level of appeal: Judicial review in Federal District Court

Synchrony Rehab is here to help you navigate through each step of Medical Review and the Appeals Process.  Let us help you in ensuring that payor reviewers recognize the medical necessity of the outstanding care you provide to your residents!