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 Assignment
- APRDRG Assignment
- Quality DRG Reviews:
- Risk of mortality
- Severity of illness
- Hospital-acquired conditions
- Patient safety indicators
- Present on admission conditions
- Data Analysis and Reports
- Identification of coding
- Document trends that affect reimbursement
- Creation of Physician 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
