DRG and Readmission Audits/Appeals
Coding and billing practices for accuracy and compliance.
Challenging payer denials to recover lost revenue.
The challenge of inexperienced coders is leading to compliance risks and wasted training resources for payers. Advize assists in addressing staffing gaps, ensuring efficient, consistent, and compliant auditing practices.
Our clinicians excel at recovering lost revenue and reversing inappropriate denials through strategic appeal tactics. We utilize technology to track and appeal cases across all payer levels and regulatory channels, combining clinical expertise with legal and regulatory knowledge.
Problem
Large payers required FWA reviews of over 300,000 high-dollar inpatient claims reimbursed on a percentage of billed charges or DRG cost outliers. The objective was to identify defects and billing errors to prevent unnecessary costs.
Solution
We conducted complex itemized billing reviews using data analytics and human intelligence. Adjustments were made in supplies consumption, hospital-acquired conditions, plan benefit coverage, implant markups, and relational billing.
Outcome
Deploying 30-40 clinical reviewers, we met the large volume of inpatient claims, achieving an average ROI savings of $11,000 per inpatient claim.
Optimize your DRG and Readmission auditing processes.
Contact us today to learn how our expertise can help recover lost revenue and ensure compliance.