Audits

With new E&M guidelines, COVID policies and specific payer clarifications audits are more important than ever for financial viability as well as compliance. More is need than just a retrospective review that indicates primarily the risks. Our data driven approach combined with expertise reviews all aspects to determine risk as well as opportunity. Much of this discovery occurs in the operations and documentation. The combination of bots, machine learning, as well as clinical experience allows us to create value and strategy from your data to give you a confidence interval for the rules.

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The interception of the billing data is a given, what goes out the door to the payer. Discover occurs at this point to determine first level of code accuracy. Documentation will be reviewed and mapped to isolate specific trends and relationships based on:

  • Disease Site
  • Gender
  • Stage
  • Instructions

Simply verifying the health of your claim is not enough and does not provide dependable or reliable information. Our ability to extract clinical data and the relational supportive elements is the distinction for what is currently available. Our process enables you to increase efficiency in workflow as well as claim accuracy. Actual numbers can be provided and not an extrapolated determination.

The added value is identifying if the correct code was use or a suggestion of a more appropriate code based on the clinical information of the:


  • The Patient
  • The Order
  • The Documentation
  • Code Level
  • Components

Your audit is provided in a traditional format for you to drill down and review.

The data is also made actionably through dynamic dashboards that allow you to quickly isolate information and see performance with our precision Power BI portal engine.

Our rules and interface engine allows for more prospective implications, while meeting the requirements of the OIG and others for the audit portion of an effective compliance plan.

We are currently applying this proven and disruptive approach to:

  • Radiation Oncology
  • Proton Therapy
  • Medical Oncology
  • Diagnostic Radiology
  • Interventional
  • Infusion
  • Asthma and Allergy