InDefend provides specialized software that enables inpatient rehabilitation facilities to comprehensively respond to an audit. Typically our software is used to respond to a retrospective denial of payment of a case. CMS regulations require hospitals to respond, which is expensive because it is challenging to defend clinical judgment and time-consuming to manage the logistical complexity of audits.
On the other hand, not defending against an audit is even more costly: in 2013 hospitals collectively lost $200 million per month in forfeited payments to Medicare alone.
InDefend was created to manage this substantive and procedural complexity. Our software offers a complete solution that virtually eliminates the logistical difficulty inpatient facilities face. Our comprehensive appeals solution requires just 1.5 employee hours from the moment of audit notification until the rehabilitation facility is ready to respond.
Teams of physicians and programmers jointly developed applications that collect patient-specific information in a structured way to meet both the clinical necessity documentation and CMS program participation requirements. Our proprietary software is the result of a unique intellectual process, including specialty-specific physician-writing teams, thorough medical literature research for best-evidence standards, and innovative programming.
Building upon extensive nationwide experience with hospital audits, the founders have created software that allows the scientific research and CMS compliance requirements to be handled by one employee (typically a case manager) in an efficient one hour process. This rapid and definitive solution creates the opportunity for a hospital to:
• win its appeal during the initial 30-day discussion period
• avoid years-long procedural delays and uncertainty
• eliminate almost all logistical complexity in managing appeals
• respond efficiently and consistently to audits
• implement a reproducible and transparent process
• budget a focused and predictable expense
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To support the documented clinical care, one of our appeal letters typically includes more than 30 references from peer-reviewed journals and textbooks, such as JAMA, Lancet, NEJM, Archives of PM&R, Am J of Cardiology, PM&R, Annals of Neurology, etc. Each appeal letter focuses on both the medical complexity of the individual case (improved outcomes, decreased complications, decreases in M&M etc.) and compliance with documentation requirements.