by Advize Admin | Nov 29, 2016 | Medical Record Auditing, Payers
The American Hospital Association recently released the results of a survey conducted to explore the efficacy of the RAC program in hospitals nationwide. The survey utilized the results responses submitted by 676 participating hospitals in order to explore the...
by Advize Admin | Oct 31, 2016 | Medical Record Auditing
Hurricane Matthew flooded headlines earlier this month as it approached Advize Health’s home-base of Tampa Bay, threatening to eliminate power-lines and productivity. The threat of the storm had the Advize Health team working in overdrive, strategizing ways to stay...
by Advize Admin | Jul 26, 2016 | FWA, Medical Record Auditing
Commercial Health Plans The act of tailoring medical record audit procedures to the needs of a particular health plan is not a novel concept. Different commercial healthcare payers maintain requirements unique to their served populations, and audits are consistently...
by Advize Admin | Jul 21, 2016 | Coding, FWA, Medical Record Auditing
A medical record audit can reveal over-payments for up-coding, incorrect numbers of units billed, and the abuse of modifiers – just to list a few. Given the popularity of such indiscretions, what is being done after the money is recovered? Do you intend on data mining...
by Advize Admin | Apr 14, 2016 | Careers, Medical Record Auditing
External auditors, or auditors who work for external auditing firms, are often trained in a variety of specialties and have experience in auditing for many different payers, providers, and facilities. Hiring an external auditor is extremely advantageous because they...
by Advize Admin | Mar 15, 2016 | Coding, Compliance, Medical Record Auditing
On March 10, Advize Health held our fifth monthly webinar on Meaningful Use and Security Risk Analysis. For this webinar, Advize Health’s auditor Melissa Jewett presented with Don Waechter from Compliance and Remediation Services, LLC. Both Melissa and Don are highly...
by Advize Admin | Feb 16, 2016 | Medical Record Auditing
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...
by Advize Admin | Jan 6, 2016 | Medical Record Auditing
The work performed by Advize Health is enacted with insurance providers and patients in mind. Protecting providers and patients from fraud, waste, abuse, and unnecessary use of money are among our priorities, and our team of auditors works hard to deliver the best...
by Advize Admin | Dec 16, 2015 | Coding, Medical Record Auditing
There are many techniques to extracting data that can range from reviewing claim line billing data to actual medical record reviews. Relying exclusively on the claims data to analyze and identify atypical billing patterns or potential red flags is always challenging....
by Advize Admin | Dec 3, 2015 | Medical Record Auditing
When the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. The role of the 22 modifier is to reflect additional work that is not typically part of the procedure,...
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