DRG and Readmission Audits/Appeals
Coding and billing practices for accuracy and compliance.
Challenging payer denials to recover lost revenue.
The lack of experienced coders is leading to compliance risks. Advize assists in addressing staffing gaps, ensuring efficient, consistent, and compliant auditing practices
Our clinicians excel at recovering lost revenue and reversing inappropriate denials through strategic appeal tactics. We utilize technology to track and appeal cases across all payer levels and regulatory channels, combining clinical expertise with legal and regulatory knowledge.
Problem
Significant payers mandated extensive FWA assessments for a vast number of high-value inpatient claims, reimbursed based on a percentage of invoiced charges or DRG cost outliers. The aim was to pinpoint anomalies and billing inaccuracies to curtail unnecessary expenditures.
Solution
We conducted complex itemized billing reviews using data analytics and human intelligence. Inappropriate payments were identified for supplies, hospital-acquired conditions, plan benefit coverage, and implant markups.
Outcome
Identifying an error rate of 66%.
Optimize your DRG and Readmission Auditing Processes.
Contact us today to learn how our expertise can help recover lost revenue and ensure compliance.