McKesson’s Pathways Compliance Advisor™ solution identifies services upfront that Medicare won’t cover and reviews claims for Medicare compliance before they’re submitted. The solution analyzes denial trends by procedure, physician, department and facility so you can identify and correct problems before they occur. The result is dramatically reduced denials and unnecessary medical services.

Benefits

The Pathways Compliance Advisor solution helps you improve claims management, access management and financial performance by:

• Reducing or eliminating write-offs due to lack of medical necessity
  
  
• Improving the claims submission process by performing back-end billing guideline checks prior to claims submission
  
  
• Ensuring comprehensive Medicare compliance and Advanced Beneficiary Notification (ABN) requirements, and offering extensive, regularly updated National Coverage Decisions (NCDs) and Local Medical Review Policy (LMRP) content services
  
  
• Reducing accounts receivable and reprocessing time by allowing a provider to submit the claim accurately the first time
  
  

Features

• Identifies non-covered procedures before care delivery, fostering Medicare compliance
  
  
• Generates an ABN, with expected charges, to document patient decision to accept liability
  
  
• Enables multiple facilities to share historical claim information for compliance checking
  
  
• Educates providers about repetitive billing issues that result in lost reimbursements
  
  
• Identifies corrections prior to claim submission to help reduce A/R days and improve claims management processes
  
  
• Provides audit trail for compliance program