Posted and filed under Medical Record Auditing.
medical record auditing for medical necessity

Auditing Medical Records for Medical Necessity

A little background, one of areas where Advize provides consulting services is in the medical record review space.  We have been providing this service to clients for over 20 years, both proactively, and reactively. Our CEO, Jeanmarie Loria, was actually a part of the development of the medical record review platform used by the Medicare contractors…

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Posted and filed under Compliance, Fraud, FWA, Healthcare.

3 Common Healthcare Fraud Schemes

Scroll through any law enforcement or OIG newsroom, and you’ll quickly learn that healthcare fraud comes in many shapes and sizes. There is no one-size-fits-all fraud scheme adopted by those looking to exploit the system for a buck (or a few million). This is what makes healthcare fraud such a persistent problem. Fraud examiners, enforcement…

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Posted and filed under Medical Record Auditing.

The Importance of Medical Necessity in Medical Coding

Medical necessity documentation, or lack of it, is one of the most common reasons for claim denials. For a service to be considered medically necessary, it must be reasonable and necessary to diagnosis or treat a patient’s medical condition. When submitting claims for payment, it is the diagnosis codes reported with the service that tells…

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