Defense of Complex Audits

A post-payment audit is the payor's opportunity to claw back claims it has already paid. The firm's signature capability is the in-house auditing function: certified coders and former auditors who reconstruct the medical record and the claim from the same vantage point the auditor used to challenge it.

Audit response and statistical sampling defense

We respond to record requests on a timeline that protects the provider, audit the auditor's statistical sampling methodology, and challenge extrapolations that do not withstand the math.

Rebuttal and reconsideration

We prepare rebuttals to the audit findings using the medical record, the coding guidelines in effect on the date of service, and the regulatory framework that governs the specific service line.

ALJ and federal review

For Medicare audits, we represent providers through the five-level appeal process, redetermination, reconsideration, ALJ hearing, Medicare Appeals Council, and federal district court.