Support for Audit Appeals Defense
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.