health-insurance-payer

After working with a variety of commercial and government payers for close to 20 years, we have seen what works and what wastes time and money. Your relationships with providers and members are important. Let us help. Our team has expanded our model of coding and billing audits focused on waste and abuse to better support your program integrity efforts.

COVID-19 Support

Advize Health assists SIU teams with data analytics, investigations, and probe and statistical sampling for COVID-19 fraud. Our retired OIG agents, Certified Professional Coders (CPC) and Correct Documentation Improvement (CDI) professionals have the expertise needed to identify the schemes being performed and are closely connected to those in the field conducting these investigations.
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Medical Record Review

In the United States, $3.6 trillion was spent on healthcare in 2018. The National Health Care Anti-Fraud Association (NHCAA) conservatively estimates that the financial losses due to healthcare fraud is 3% of total health care expenditures, while some government and law enforcement agencies place the loss as high as 10%, or over $300 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.
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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

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 Healthcare fraud schemes can range from simple to very complex. Doing your job efficiently is just as important as doing it effectively. We customize education for teams large to small, covering everything from effective documentation management and maintenance to the best practices when interviewing.

Course Example: SIU Team Training