Coding Appropriateness

We identify recurring error patterns that lead to provider violations of payor agreements. Our forensic coding reviews prioritize high-risk DRGs to identify recurring error patterns and billing-compliance gaps by producing fully defensible, evidence-based audits that legally validate appropriate reimbursement levels.

DRG Clinical Validation

We proactively identify unsupported comorbidities and sequencing discrepancies to ensure accurate reimbursement and reflect the actual acuity, resource utilization within a claim. CC/MCC capture, principal-diagnosis selection, and DRG assignment are all subjected to physician-led clinical scrutiny.

Payment Line-Item Claim Review

We audit procedure and diagnosis codes at the claim level to detect inappropriate bundling, upcoding, and documentation mismatches.

Forensic Medical Audits

Our team conducts granular forensic reviews of clinical records, prioritizing high-risk DRGs and billing-compliance gaps. The result is a fully defensible, evidence-based audit that legally validates appropriate reimbursement levels.