Services

Personal Scrutiny Proprietary Technology

Nurse Audit individually analyzes every medical claim utilizing our clinical screening tools and proprietary database of provider recovery history. This meticulous, research-driven process, conducted for medical bill audits and DRG validation audits, offers an extra level of claim screening that enables us to detect overlooked coding and billing errors which reveal healthcare cost containment opportunities for our clients.

Our state of the art computer system is driven by the latest technology available, permitting a secure electronic interface with our clients through all phases of the audit process, while still providing the personal touch only years of experience can deliver.

Cost Containment Programs

• Pre-Payment Negotiation Services
• DRG Validation Program
• Inpatient and Outpatient Provider Bill Audit Program
• CPT Code Review with Claim Analysis Program
• High Cost Implant and Pharmacy Audit Program
• Workers' Compensation Bill Analysis Program

Program Compatibility

We work with virtually all reimbursement methodologies including:

• Discount off of charges
• DRG
• Stoploss thresholds
• Carved-out reimbursement
• CPT based fee schedules

Consulting Services

• Audit Policy Development
• Provider Payment Policy Development and Implementation
• Contract Language Enhancement and Development

Customized Solutions

Motivated by a desire to creatively serve our clients, Nurse Audit customizes unique programs and provides valuable consulting services-thoroughly and creatively.