healthcare medical record review

Medical Record Review

Billing for evaluation and management (E/M) services are often subject to errors, fraud and abuse. According to the Office of Inspector General, Medicare payments for E/M services have increased roughly 43% from 2001 to 2010 (from $22.7 billion to a staggering $33.5 billion).

Payers can minimize this risk with Advize Health. Our cost-effective and efficient medical record review services identify inconsistent documentation between clinical records and claim payment data. Our highly-skilled team of experts has performed coding and billing audits in both private and public sectors (state, RAC, and CMS) for a combined total of nearly 225 years, and has a range of certifications, including: RN, CPC, CPC-H, CPC-I, CCS-P, CIRCC, CPCO, CPMA, CEMC, CHC and CFE.

At Advize, we produce an honest and credible medical record review that fully explains how the codes were determined, down to the actual elements within the medical record. By using our services, you can reduce expenses and improve Medical Loss Ratios (MLR), allowing you to concentrate on providing high-quality healthcare and improve your bottom line.

  • Project-Focused Approach
    • We offer straightforward healthcare review service with a focus on clear and frequent communication.
  • Delivery of Clear ROI
    • The “Standard Audit” is customized during the contracting phase to ensure services and value to the client are a perfect fit.
  • Responsive
    • Our proprietary auditing solution enables us to process claims quickly and accurately through our proven case management system.
  • Adaptable
    • Other services, such as those listed below, are provided at competitive rates.
      • Custom Reporting
      • Fraud Identification
      • Unbiased and Objective Review
      • Provider Inquiry Management

By adhering to a standard project management process, Advize Health ensures clear communication and effective results. Our solution allows clients constant access to view project reports, check statuses, and review individual provider or claims results. We have a track record of proven results that include:

  • Minimized Network Impact
    • Reduced turnaround time with a cost effective and efficient process
  • Cost Containment
    • Lowered costs by augmenting your staff with our technology and our auditors
  • Claim Level Manual Reviews
    • Reduced billing errors and elimination of fraud, waste, and abuse
  • Mitigate Risk
    • Reduced potential future over-payments through provider education

Consulting Services

The Advize Health focus extends beyond medical record reviews into the following services to help organizations deliver better healthcare:

  • Policy and Procedures
  • Education and Training
  • Risk Adjusted Rating
  • Medical Necessity
  • Over-Utilization
  • Dental

Education

  • Teaching Hospital Reviews
  • Educational Reviews