The DoctorsManagement Audit and Appeal Team Possesses:
A thorough understanding of the appeals and litigation process and comprehensive knowledge of federal and state laws, guidelines, statutes and regulation that steer the industry regarding compliance.
Extensive insight to the OIG, DOJ and AUSA as well as Central CMS (not the same as the MACs)
Relationships with government representatives including key members of the Congress and Senate (Senate Finance Committee), and Central CMS.
Use of language in communications that achieve results when requesting extensions as well as .
Communication skills that elicit response from government officials that cut through language that attempt to use their knowledge of the system and its loopholes to gain advantage.
Coding audit capabilities to review the claims in question (and provide a corrective action plan) using both attribute and variable statistical analysis to ensure proper samples are drawn.
Experience with focused reviews that balance both the quantifiable or “Medical Necessity” aspect with the qualified or clinical aspect of an audit.
Ability to question prohibited procedures that payers may be attempting to use in a concealed manner.
Multiple certifications and workflow procedures that include some of most comprehensive QA processes to validate audit findings.
Ability to present executive summaries that concisely outline audit results for each situation identified as well as comprehensive reports that are used in Civil Investigative Demands (CIDs / Interrogatories), State and Federal Hearings and for attorneys representing health care providers that are in need of independent and objective subject matter expert guidance.
Certified Professional Coder (CPC®) – an individual who has passed a coding certification examination sponsored by the American Academy of Professional Coders (AAPC).
Certified Professional Medical Auditor (CPMA®) – an individual who has passed an auditing certification exam sponsored by the American Academy of Professional Coders (AAPC).
Other, specialty certifications – (create a pop-up list of all the certs???)
National Alliance of Medical Auditing Specialists (NAMAS) – a division of DoctorsManagement, NAMAS provides ongoing support and training to DM’s auditing team as well as to auditing professionals across the country.
Access to ComplianceRiskAnalyzer™ (CRA) – CRA is a proprietary technology that accurately and rapidly identifies potential coding and billing compliance risks.
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