medical record audit law arbitration

Expert Claims Review and Reporting

A claims review and the subsequent reporting can make or break a case. Relieve your firm of the pressures of delivering an accurate, effective review and use the expertise of our claims review consultants. Deeply experienced in all audit domains, from DRG to UPIC and everywhere in between, our team of auditors, claims review specialists, statisticians, and expert witnesses will work with counselors throughout the lifecycle of a case.

Review Capabilities

  • Multi-level claims review from Certified Coder level through Peer-Review and Clinician tiers
  • Full fraud, waste, and abuse analysis of billing and medical charts across all specialties
  • Medical necessity review
  • Identification of upcoding/downcoding across all specialties
  • Consulting and recommendations for payment edits, investigative next steps, review of criminal, civil and administrative violations

Compelling Reporting

Standard Reports include:

  • Staffing/Provider Structure and Organization
  • Audit Scope
  • Audit Methodology
  • Audit Sample Information
  • Individual Practitioner Billing Review and Trends
  • Key Audit Findings and Reporting
  • Quality of Clinical Documentation and Practices
  • Customizable appendixes and modules based on client needs

SMEs and Expert Testimony

With a proven-track record of successful reviews and reporting, Advize Health’s staff is trained and comfortable presenting results and reports in both the boardroom and the courtroom.

SME Capabilities

  • Provide expert analysis of DRG repricing in federal criminal cases across all medical specialties
  • Identify and report on medical necessity and associated findings
  • Litigation support for the purposes of sentencing through testimony
  • Subject matter expertise on billed vs. paid amounts, loss, US Sentencing Guidelines, investigative practices employed by organizations such as the OIG

Resources