About Us

Our Focus

Healthcare payors rely on our cost containment programs to identify coding and billing errors by medical providers and to avoid overpayment.  Our work is especially critical as healthcare expenditures continue to rise and payors face a multitude of cost-related challenges. Nurse Audit offers pre- and post-payment audit and review programs including:

• Provider bill audits

• DRG validation audits
• CPT code & clinical reviews
• High cost implant audits
• High cost pharmaceutical audits
• Provider bill negotiation services

Our medical claims audit services focus on identifying billing errors and non-compliance with provider contract terms. We also assist with the development of and/or enhancement of new or existing payment policies which address revenue optimizing provider billing practices.