MEDICAL CLAIM REVIEW
by Certified Physicians
Our medical claims review team is composed of U.S. Certified Physician reviewers who analyze medical records to ensure all billable diagnoses and procedures are captured and coded following the most up-to-date clinical guidelines.
Their training allows them to review charts form a clinical view, to quickly identify opportunities to maximize coding and engage hospital physicians through the creation of physician queries.
- DRG Review - Day 1 Impact
- Mitigate Risk of Denials
- Review Medicare, Medicare Advantage, and Commercial Claims
Ensure Accuracy & Compliance
Pre-Bill Medical Claim Review by Experienced U.S. Trained Physicians
DRG Review
MSDRG Asssignment
APRDG Assignment
Quality DRG Reviews
- Risk or morality
- Severity of illness
- Hospital-acquired conditions
- Patient safety indicators
- Present on admission conditions
Data Analytics & Reports
- Identifications of coding
- Document trends that affect reimbursement
Creation of Physician Query
Query Appeals
Medical Necessity Denials
Claim Denial Reason Codes
Clinical Validation Denials
Custom Consulting
- Physician engagement and collaboration with coding and CDI staff
- Revenue projections and valuations of practices or service lines
Request a FREE Claim Assesment
(200 - 250 Claims) or 90-Day Review
