#AugustWebinar 🚨 💡Medical Auditor or Medical Coder and the Importance of Internal & External Audits Eric Rubenstein, MSCJ, CFE and Dena Bland, RN, CPC, a member of Advize’s UPIC clinical documentation auditing team, discuss the differences between coders and auditors, emphasizing that clinical audits have a much broader scope than coding assessments. They cover medical necessity considerations, revenue cycle management, and overall corporate compliance and stewardship as critical parts of the auditing continuum.
Advize
Hospitals and Health Care
Orlando, Florida 34,172 followers
Healthcare & IT Audit & Advisory, Program Integrity, Compliance and Consulting for Payers, Providers, Legal & Government
About us
After nearly two decades of auditing large data sets and performing extrapolation for increased ROI for payers, Advize has shifted focus to building relationships with providers based on data and best practices. Our team has expanded our model of coding and billing audits focused on waste and abuse to examine fraud through Big-4 Data Analytics and OIG best practices. Audit and Support Services – Record Retrieval, Storage, Purge – Onsite record retrieval – Send request letters and other communications with providers – Secure file upload (SFU) – Records are stored securely and discarded in accordance with HIPAA recommendations and requirements – Minimum necessary PHI accessed – Record files are securely returned with audit result delivery – Corporate Integrity Agreements – Statistically valid sampling – Medical necessity and proper coding/documentation review – Audit Management and Quality Assurance Support – QA Review – Reporting and Results Delivery – Overpayment Recovery and Overpayment Support – Legal Support – Case building, expert witness, audit, reporting and testimony Review and Reporting – Reviews performed by highly experienced and credentialed auditors – Audit personnel work with a variety of healthcare personnel and patients. They should always conduct themselves in an acceptable, professional manner and adhere to ethical standards, confidentiality requirements, and objectivity. Auditors trained to completely document their findings and problems. – Perform verification of charges – What citations are important, and what policies are important? – Citation guidebook creation – Review of claims – Generation of preliminary audit results – Results delivery and collaboration with client – Report generation – Final Audit Results: – Contain final audit reporting, this reporting will have included the overpayment amount. – Review the next steps for the provider who was audited.
- Website
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https://advizehealth.com
External link for Advize
- Industry
- Hospitals and Health Care
- Company size
- 51-200 employees
- Headquarters
- Orlando, Florida
- Type
- Privately Held
- Founded
- 2003
- Specialties
- Litigation Support, Medical Necessity, Record Collection, Claims Review, Healthcare, Claims, Healthcare Legal Support, Medical Records, Consulting, Expert Witness, HITRUST, FWA, OIG, CMS, UPIC, DRG, HCPCS, Arbitration, Audit, Advisory, Medical Record Audit, SIU, Compliance, Analytics, Federal, Healthcare Consulting, Expert Testimony, Hubzone, Women Owned, Government, and CPC
Locations
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Primary
Orlando, Florida, US
Employees at Advize
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Jeanmarie Loria, MBA, PMP, CPC
CEO, Advize Health
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Brian Boyce
CEO, MHA, Risk Adjustment, RADV, HRADV, Clinical Bioethics, Healthcare Operations Consultant & Auditor Aeromedical Air Force Vet, Entrepreneur…
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Jaysen Eisengrein, MBA, PgC, SAC (RET)
Retired HHS OIG Special Agent in Charge/Advize Health Special Director in Charge/FWA Consultant
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Pamela Jones
Transformative leader and mentor. Accredited in Case Management/Utilization Management. Home Health/Hospice, Heath Plan and Appeals leadership…
Updates
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We're #hiring a new Medical Coding Auditor in United States. Apply today or share this post with your network.
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Is healthcare still about the patient? In our latest blog, we explore how the system's priorities have shifted and what needs to change to bring the focus back to patient care. What do you think? Have you noticed these changes in your own experience? What would you like to see more of in healthcare? Let's start a conversation—your insights matter! #HealthcareReform #PatientCare #HealthcareIndustry #WellnessFirst #HealthcareMatters #AdvizeHealth #EthicalHealthcare #PatientCenteredCare #HealthcarePriorities #TransformingHealthcare
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🌟 Join Our Growing Team at Advize Health! 🌟 Advize continues to expand thanks to our success with our partners. We're currently seeking experienced professionals to join our Medical Record Review Team for a 4-6 month contract project, with the possibility of extension. What We're Looking For: ✅ Certified Professional Coder (CPC) or Certified Professional Medical Auditor (CPMA) with a minimum of 2 years of experience ✅ ProFee Auditing Experience (HCC experience will not be considered) ✅ Behavioral Health Experience (Must be documented on your resume) ✅ SIU/FWA Experience ✅ Experience using NCD/LCD/LCA to make medical necessity determinations ✅ Strong knowledge of CPT/HCPCS related to professional fee services ✅ Medicaid Policies Knowledge is a plus This is a great opportunity for individuals in earlier stages of their career, with 2-5 of experience. Important: Candidates must reside in the U.S. and be eligible for employment (we are not sponsoring visas). 📩 If your resume meets the above criteria, email it to erubenstein@advizehealth.com. Only candidates meeting the requirements will be contacted for further action. #MedicalCoding #MedicalAuditing #HealthcareJobs #HealthcareHiring #ProFeeAuditing #BehavioralHealth #SIU #Medicaid #FWA #HealthcareProfessionals #CPC #CPMA #AAPC #HealthcareCareers #JobOpportunity #ContractJob #HiringNow #AdvizeHealth #RemoteWork
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#LetTheGoodTimesRoll Exciting Conference Season Ahead! 🚀 Medicaid is at the forefront of our discussions, and we’re thrilled for two fantastic upcoming events! 🌟Next week, we’re diving into the latest in Medicaid at #MESC2024 in Louisville, KY. 🌟And in just two weeks, we'll be soaking up the energy and insights at #NAMPI2024 in vibrant New Orleans, LA. So, here’s the big question: Are you Team Louisville or Team NOLA? 🤔 Where will we get to see you? Drop your plans in the comments and let’s connect! #Medicaid #Healthcare #MESC2024 #NAMPI2024 #Networking #ConferenceSeason #Medicaid #HealthcareEvents #HealthInnovation | Jeanmarie Loria, MBA, PMP, CPC
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🔥The OIG Roundtable Episode 89: How Small Plans Make it Work In this episode, Eric, Wade, and Matt dive into the impressive successes of Arkansas Blue Cross and Blue Shield under the leadership of Debbie Gunter. While we haven’t had the pleasure of meeting Debbie personally, her team’s achievements have caught our attention and were recently highlighted in an industry article. Join us as we break down the remarkable ROI they’ve achieved and explore how their approach can serve as a model for other plans across the country. Whether you’re part of a large or small team, this episode offers valuable insights on maximizing efficiency and driving results in healthcare. 🔗Tune in to Episode 89 now and discover how small plans can make a big impact! #PodcastLaunch #HealthcareInnovation #ROI #Leadership #SmallPlansBigImpact #OIGRoundtable #HealthcareExcellence https://lnkd.in/edy2smXg
OIG Roundtable 89: How Small Plans Make it Work
https://www.youtube.com/
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What’s the Impact? Sure, Medicare policymaking is complex, but what can we do to address the challenges? Navigating the dynamic environment of risk evaluation in Medicare populations requires a delicate balance between necessary care and accurate assessments. But how well are we managing this balance? Ensuring sustainability, delivering quality care, and aligning financial incentives for providers—does this approach create more problems than it solves? Understanding these dynamics is crucial for developing transparent and accountable policies that lead to optimal care outcomes and safeguard healthcare for millions of Americans. What are your thoughts on this critical issue? #HealthcarePolicy #Medicare #Policymaking Thanks, Garrett Gilbert, for inspiring these thoughts: https://lnkd.in/e5R-xwa5
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In our latest OIG Roundtable #Podcast episode, launching later today, we will dive deep into the strategies that make small teams like Arkansas BC/BS so successful, particularly under the leadership of 👑Debbie Gunter. While we haven't had the pleasure of meeting Debbie personally, her team's remarkable achievements speak volumes 👏 🚀 Key Highlights: - Proactive vs. Reactive Work: Discover why proactive investigation is just as crucial as reactive measures. - Vetting Complaints: Learn how setting a reasonable threshold for case value can optimize resources and maximize ROI. - Impressive ROI: We explore how even a modest ROI, such as $2 or $3 returned for every $1 invested, is a significant selling point for securing additional funding. - Collaboration is Key: See how working closely with other entities amplifies success. Join us as we break down these strategies and discuss the impressive results achieved. This episode is packed with valuable insights that could transform your approach to investigations and resource management. 🔗Tune in now to listen and gain actionable strategies for your team! #HealthcareInnovation #SIUExcellence #ProactiveInvestigations #TeamSuccess #Leadership #BusinessGrowth #OIGRoundtable #NewEpisode #ROI #StrategicPartnerships
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We're #hiring a new Behavioral Health Coding Auditor (Outpatient) CPC or CCS Certified in United States. Apply today or share this post with your network.
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⭐Small teams can achieve monumental change⭐ The secret? Partnering with the right people. 🎯Key Tips for Success: - Leverage Strategic Partnerships: Collaborate with experts to extend your reach and enhance capabilities. - Focus on Core Competencies: Align partnerships to complement your team's strengths. - Communicate Clearly: Maintain transparent and regular communication with partners. - Set Clear Goals: Define and align goals to drive collaborative success. - Share Resources: Pool resources and insights for innovative solutions. - Celebrate Milestones: Recognize and celebrate achievements to boost morale. In our upcoming OIG Roundtable #Podcast episode, we’ll delve into these powerful strategies and reveal real-life success stories that will inspire and transform your approach. Please stay tuned 🚀 #PodcastLaunch #BigImpactSmallTeams #StrategicPartnerships #TeamSuccess #Leadership #Innovation #StayTuned #FOMO #PodcastEpisode #BusinessGrowth