DRG Validation
We ensure a comprehensive coding review and clinical validation to ensure accurate reimbursement. The codes billed are accurate or corrected when compared to patients’ medical records. Our experienced team of reviewers are guided by our Medical Director and use enhanced technology to ensure all the right corrections are made in a timely manner.
Data Mining
Professional Claim Review
Hospital Bill Audit
Our most in-depth review, Hospital Bill Audit is a thorough evaluation of all potential records—from itemized bills and medical records to nurse and operative notes.
Fraud, Waste, and Abuse
With financial losses due to healthcare fraud in the tens of billions of dollars annually, we offer a suite of fraud detection solutions. These include special investigation unit analysis and lead services, multiple fraud scanners detecting suspicious activity on pre and post pay claims, dashboards and reporting, and FWA consulting to aid in prevention, remediation, and more.
