OnTarget Revenue delivers a fully electronic, end-to-end solution for managing Medicare post-payment audits—specifically RAC, CERT, TPE, and QIO audits such as those from Livanta. Our platform automates every stage of the audit and appeal lifecycle, accelerating turnaround time, improving compliance, and protecting revenue.
Fully Electronic Medicare Audit Management
- ADR Request Letters: Automatically received and logged—no need to monitor shared inboxes or fax queues.
- Medical Record Submission: Documentation is transmitted securely through esMD or payer portals.
- Results Letter Processing: Audit findings are automatically read, categorized, and matched to the original claim.
- Discussion Submission: If applicable, discussion requests are submitted electronically—ensuring deadlines are never missed.
- MAC & QIC Appeals: Level 1 (Redetermination) and Level 2 (Reconsideration) appeals are fully supported via structured, paperless workflows.
- Electronic Remittance Review: Remittance files are monitored to track recoupments, identify appeal wins, and verify claim reversals in real time.
- Notes Posted Back to HIS: Audit outcomes, appeal steps, and compliance notes are posted directly into your hospital’s information system—including EPIC—eliminating dual entry and keeping your internal records up to date.
Aligning with CMS Appeal Workflow
Our platform automates every level of the CMS appeals process.
View the Full Medicare Appeals Workflow »
Why Full Automation Matters
- Speed: Process and respond to ADRs, discussions, and appeals faster than any manual workflow allows.
- Accuracy: Automation ensures no step is missed—minimizing late submissions, misfiled documents, or lost appeal opportunities.
- Deadline Protection: Every stage—ADR submission, Discussion requests, and appeals (MAC, QIC, ALJ, DAB, Federal)—has strict timelines. Automation ensures nothing falls through the cracks.
- Compliance: Meets CMS submission and audit trail standards, including esMD protocols and secure document handling.
- Appeal Wins: Structured submissions and system-driven completeness checks improve success rates across all audit types.
- Eliminates Dual Entry: By posting audit activity and appeal outcomes directly into the HIS (including EPIC), our platform reduces manual rework and ensures internal records are always up to date.
Whether facing a simple coding correction or a complex medical necessity dispute, OnTarget Revenue equips your team with the tools to respond confidently and efficiently—at every stage of the Medicare audit process.
