After nearly two decades of auditing large data sets and performing extrapolation for increased ROI for payers, Advize has shifted focus to building relationships with providers based on data and best practices. Our team has expanded our model of coding and billing audits focused on waste and abuse to examine fraud through Big-4 Data Analytics and OIG best practices. 

Audit and Support Services
–	Record Retrieval, Storage, Purge
–	Onsite record retrieval 
–	Send request letters and other communications with providers
–	Secure file upload (SFU)
–	Records are stored securely and discarded in accordance with HIPAA recommendations and requirements
–	Minimum necessary PHI accessed
–	Record files are securely returned with audit result delivery
–	Corporate Integrity Agreements
–	Statistically valid sampling
–	Medical necessity and proper coding/documentation review
–	Audit Management and Quality Assurance Support
–	QA Review
–	Reporting and Results Delivery
–	Overpayment Recovery and Overpayment Support
–	Legal Support
–	Case building, expert witness, audit, reporting and testimony

Review and Reporting
–	Reviews performed by highly experienced and credentialed auditors
–	Audit personnel work with a variety of healthcare personnel and patients. They should always conduct themselves in an acceptable, professional manner and adhere to ethical standards, confidentiality requirements, and objectivity. Auditors trained to completely document their findings and problems.
–	Perform verification of charges 
–	What citations are important, and what policies are important? 
–	Citation guidebook creation
–	Review of claims
–	Generation of preliminary audit results
–	Results delivery and collaboration with client
–	Report generation
–	Final Audit Results:
–	Contain final audit reporting, this reporting will have included the overpayment amount.
–	Review the next steps for the provider who was audited.

Support Services

Advize

Advize's headquarters in Orlando, FL, United States

Jeanmarie Loria

Dan Leslie

Ethan Montgomery

Robin L. Kessinger

Cpc David Bolden Cpco

Julie Janeway

Jeanmarie Loria Mba, Pmp, Cpc

The Clinical Audit and Assessment Team at Advize specializes in conducting thorough audits of medical records and billing practices to identify instances of fraud, waste, and abuse. Leveraging Big-4 Data Analytics and OIG best practices, the team ensures compliance with regulatory standards by performing detailed reviews of medical necessity and coding accuracy, generating comprehensive reports, and collaborating with healthcare providers to rectify any discrepancies. Additionally, they provide legal support and expert testimony as needed, ensuring that all audit activities are conducted with the highest standards of professionalism, confidentiality, and ethical integrity.

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About

People

Brittany McClafferty

Bsn Lisa Moore Rn, Cpc

Dena B.

Janice Brown

Michelle Dolinski

Msn Nana Grant Rn

Robin L. Kessinger

Sandra Pletz

Sheri Vickery

Stefanie Lawrence

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About

People

Brittany McClafferty

Bsn Lisa Moore Rn, Cpc

Dena B.

Janice Brown

Michelle Dolinski

Msn Nana Grant Rn

Robin L. Kessinger

Sandra Pletz

Sheri Vickery

Stefanie Lawrence

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