Audit &
Appeal Support
We provide strategic preparedness for complex federal audits, for Traditional Medicare, Medicare Advantage Plans and Medicaid, ensuring your organization is protected and positioned for success.
We provide support for initial audit requests and any level of appeal.
We provide an in-depth analysis of identified strengths and opportunities for improvement.
We provide expert audit support, documentation review, and defensible compliance strategies to help providers respond efficiently and minimize financial exposure.
Medicare Administrative Contractor (MAC) Audits - ADRs
We identify documentation gaps, reinforce clinical accuracy, and align your records with payer expectations so you get paid without delays.
Unified Program Integrity Contractors (UPIC) Audits
UPICs move fast to find fraud, waste, and abuse. We close compliance gaps, work to strengthen documentation integrity, and ensure every claim meets Medicare’s strict investigative standards—protecting you from recoupments and escalations.
Recovery Audit Contractor (RAC) Audits
Our RAC response services help you defend revenue, reduce repayment risk, and navigate complex Medicare and Medicaid audits with confidence. As CMS-contracted Recovery Audit Contractors aggressively identify overpayments through claims reviews, coding validation, and statistical sampling, we provide the expertise, documentation support, and compliance strategies providers need to respond effectively and protect financial performance.
Supplemental Medical Review Contractor (SMRC) Audits
Our SMRC audit response services confidently manage complex CMS reviews while protecting revenue and reducing compliance risk. As the Supplemental Medical Review Contractor (SMRC) targets claims for coverage, coding, billing, and payment accuracy, we provide expert audit support, documentation review, and defensible compliance strategies to help providers respond efficiently and minimize financial exposure.
Comprehensive Error Rate Testing (CERT) Audits
Our CERT audit support services reduce improper payment risk and strengthen Medicare Fee-for-Service compliance. We assist with documentation review, coding validation, claim accuracy analysis, and audit response strategies designed to improve defensibility, minimize payment errors, and protect reimbursement during Comprehensive Error Rate Testing (CERT) reviews
Review Choice Demonstration - (PCR)
Targeted Probe and Educate (TPE) Audits
Our experts can review your clinical documentation to ensure it meets the rigorous standards required for Medicare reimbursement prior to billing.
Focused Hospice Audits
Our experts can help you navigate and respond to government oversight for both program integrity and administrative claims processing
Operational Excellence and Compliance Support
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Regulatory compliance program support
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CMS audit preparedness and response (RAC, SMRC, CERT, UPIC, ADR)
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Documentation review and coding accuracy improvement
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Billing and reimbursement integrity assessments
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Quality assurance and performance improvement (QAPI) support
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Clinical documentation optimization
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Hospice eligibility and homebound compliance reviews
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ADR management and appeal support
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Prepare for and appear on your behalf at Administrative Law Judge Hearings
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Staff education and compliance training
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Operational workflow and productivity improvement
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Revenue cycle and claims denial reduction strategies
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Policy and procedure development
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Risk assessments and corrective action planning
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PEPPER report analysis and utilization review
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Medicare Conditions of Participation (CoPs) compliance support
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OASIS and HIS/HQRP accuracy reviews
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Coding
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Data analytics and compliance monitoring
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Customized compliance solutions tailored to agency needs
Our services are customizable to your organization’s needs—providing as much depth and support as needed to meet federal, state, and accrediting body compliance standards.
Strengthening Clinical Compliance
and Documentation Practice
Home Health and Hospice Documentation Training
Empower your clinical team with specialized training programs focused on documenting the care provided so that you can get paid. We bridge the gap between complex federal regulations and clinical practice, ensuring accurate assessments and consistent documentation.
Clinical Record Audits
We provide meticulous documentation reviews to ensure your clinical records meet the rigorous standards of CMS. Our experts identify gaps and implement corrective actions to protect your organization from revenue risk.