Clinical Review & Resolution
Our hands-on inpatient clinical and financial review leverages CMS clean claim principles and focuses on inpatient claims.
This payment integrity solution performs a thorough and comprehensive review of each claim’s itemized bill to identify defects and improprieties. Our payment integrity solution employs sophisticated technology and data analytics in addition to expert clinical review by nurses, physicians, accountants, and certified coders to identify errors and compliance issues before the claim is paid. Once billing adjustments have been identified, our expert resolution team of negotiators and medical professionals work with the provider to explain our findings and come to an equitable resolution.
High-dollar, inpatient reviews can take a few different paths and can be modified to fulfill client needs. At the core of the service is our Prospective Inpatient Claim Review report which identifies line items and amounts to be adjusted prior to payment. Adjustment categories include:
