Additional Services

• Medical Audit Services
  • Financial Claims Audits
  • Pre-payment Medical Bill Screening

• Health Insurance Consulting
  • Procedural Efficiency
  • Claims Administration Procedures
  • System Integration and Development
  • Resource acquisition

• Claims Adjudication Audits (Third Party / TPA audits)
  • Client defined audit criteria and scope of review (i.e.)
  • Repricing correct
  • Deductible correct
  • Duplicity of payments
  • Case compensability
  • Appropriate investigation for pre-existing
  • Documentation to support payment found
  • Coordination of Benefits

• On Site Case or Telephonic Case Management
  • Patient visits to hospital / rehab facility
  • Record Review for criteria compliance
  • Participation in patient case conferences
  • Discharge planning
  • Home health care arrangement
  • Durable medical equipment arrangement
  • Home visits to patient (if needed)
  • Report preparation
  • System documentation
  • Participation in case management meeting

• Medico-legal case review and report
  • Insurance Policy Review
  • Case Compensability and Eligibility
  • Usual and Customary Fee Evaluation
  • Coding / Documentation Evaluation
• Reinsurance Report Preparation

• Practice Management assistance
  • Set up
  • Human Resources
    • Employee Handbook
    • Staffing/Recruiting
    • Benefits
    • Salary Analyses
  • Development of Office Procedures / Workflow
  • Fee Schedule Determination
  • Self-Audit Program Development
  • Claim Submission / Billing

Please call us to discuss how these services can benefit you and your plan.

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