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Category: Medical Review

Pre-Claim Review: It’s Baaaack — CMS Re-Proposes Home Health Pre-Claim Review

  • By Sandy McCleve
  • June 5, 2018
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Know these 3 crucial differences between the old and new PCR program. Just when you thought Pre-Claim Review was in your rearview mirror, Medicare has put the reviled prepayment review … Continue Reading →

Medical Review: Criteria To Get Off TPE A Bit Easier Than Probe & Educate

  • By Sandy McCleve
  • May 31, 2018
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Expert: Crucial data missing from TPE report. One HHH Medicare Administrative Contractor’s TPE results report provides some valuable data that will help agencies navigate TPE medical review. For example: For the … Continue Reading →

Medical Review: Boosting Your Billing Accuracy With TPE Education Could Help Avoid More Punishing Review

  • By Sandy McCleve
  • May 2, 2018
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Don’t wait until the round is over to implement improvements. Seeing the error of your billing ways — and changing them immediately — could get you off punishing Targeted Probe … Continue Reading →

Medical Review: Pay Attention To Midstream TPE Education

  • By Sandy McCleve
  • April 12, 2018
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Improving your billing rate in the middle of a Targeted Probe & Educate round could save you. Seeing the error of your billing ways — and changing them immediately — … Continue Reading →

Audits: Use These 8 Pointers To Prepare For Medical Review

  • By Sandy McCleve
  • April 2, 2018
  • No Comments

  Target your education efforts by using your self-audit findings. Don’t wait until it’s too late to get ready for potential Recovery Audit Contractor reviews of your claims. And the … Continue Reading →

Medical Review: Use These 8 Pointers To Defend Your Claims Against F2F & Cert Denials

  • By Sandy McCleve
  • March 22, 2018
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Will new F2F clinical template help you? Scrutiny of your claims is heavier than ever, and physician certification — including the face-to-face encounter — is a hot target for reviewers. … Continue Reading →

Medical Review: Don’t Be Surprised If RAC Review Is Around The Corner

  • By Sandy McCleve
  • March 22, 2018
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Monthly billing make hospice claims a tempting RAC target. Recovery Audit Contractor Performant has yet to name a specific audit topic related to hospice, but that doesn’t mean you shouldn’t worry about … Continue Reading →

OASIS: Prepare For OASIS-D To Hit In January

  • By Sandy McCleve
  • March 22, 2018
  • No Comments

Setting your implementation schedule is still a bit tricky. Just when you were feeling comfortable with the current version of OASIS, get ready for a new one. As promised in … Continue Reading →

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About Me

Sandy McCleve is the Managing Director at Advantage Healthcare Consulting with nearly a decade of experience as an accounting and tax preparation consultant specifically for healthcare providers.

Sandy has developed proprietary tools and systems that allow Advantage Healthcare Consulting to provide the fastest, most accurate cost reports and truly qualifies him as a specialist in Medicare and Medicaid Cost Reporting for Home Health Care Agencies, Hospice Care Providers, and Skilled Nursing Facilities.

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