Medicare and Medicaid appeals management

Successfully manage your appeals process.

Executive Health Resources® (EHR) physician advisors, now a part of Optum™, can help your hospital effectively manage your appeals process.

In the government's effort to root out fraud, waste and abuse, program integrity audits are now commonplace. In today's audit rich environment, denials are inevitable and hospitals must be prepared to defend their admission decisions to protect their reimbursements. Ongoing activities by Recovery Auditor Contractors (RACs), Medicare Administrative Contractors (MACs), and other entities have left hospitals struggling to identify how to best respond and prioritize their audit response efforts.

EHR physician advisors, now a part of Optum, can help your hospital effectively manage your appeals process. EHR has extensive experience with all stages of the Medicare appeals process and has achieved unmatched success in identifying and obtaining the reversal of thousands of inappropriate government contractor denials at all levels of appeal. EHR's methodology combines expert physician clinical expertise, focused on medical necessity, with legal and regulatory arguments so all appeal avenues are explored.

Today, EHR serves as the industry’s leading appeals management service provider with tens of thousands of successfully overturned denials.

Not sure how to build a best-practice RAC response team? Let us help. Read more.

Changing health care rules and regulations focused on medical necessity are a continual source of confusion for hospitals and other health care providers. To stay on top of the latest news and strategies regarding medical necessity compliance and appeals management, EHR has created The Compliance Library.