View 2023 PDPM Calculator >

Medical Review & Clinical Compliance

What We Do

Medical Review Overview

QRM offers comprehensive medical review services with an emphasis on process development, management strategies and risk mitigation.

Our team of experts focus on the management of multi-claim contractor audits involving MAC, SMRC and UPIC probe reviews.

QRM optimizes your Medicare, Medicaid and Managed Care reimbursement opportunities through onsite and offsite analysis of coding, billing, clinical documentation and educational opportunities. We establish and review internal billing and documentation processes while also focusing on the recovery of lost revenue.

"Ashley has been amazing to work with! She is knowledgeable, patient and kind. I wanted to let her know how much I truly appreciated her for being available to answer my calls when I have had questions regarding Medical Review processes and technicalities. She has been a great mentor as she explains the "why" and "how" or processes verses just giving short-ended answers/directions."

Lorraine, Director of Medical Review

"Ashley has been amazing to work with! She is knowledgeable, patient and kind. I wanted to let her know how much I truly appreciated her for being available to answer my calls when I have had questions regarding Medical Review processes and technicalities. She has been a great mentor as she explains the "why" and "how" or processes verses just giving short-ended answers/directions. "

Lorraine, Director of Medical Review

The More You Know

FAQ



Our experienced medical review team provides:

  • Billing analysis to identify required supporting clinical documentation, ensuring all submission components are incorporated into requests
  • Continuity and consistency for the achievement of successful medical review outcomes
  • Efficient and effective management of medical review activity, freeing providers from the burden of a potentially cumbersome, expensive and time-consuming process

 

  • By providing education/training to key facility personnel
  • Through the provision of organizational/management strategies for systematic medical review submissions of the highest quality
  • Through skilled identification of risk areas to eliminate the potential of surprise findings

 

  • Success rate with TPE management
  • Established rapport and familiarity with review contractors across all MACs and payor types
  • Timely management and control of the medical review process for the preservation of cash flow

We focus on the details

Our RAC-CTA specialists offer guidance on:

  • System implementation for reducing and preventing denials
  • Management of MAC diagnosis edit denials
  • Management of documentation requests
  • ADR packet preparation, organization and submission
  • Management of appeals
  • Pre and post-payment probe review and UPIC guidance
  • Reporting of your medical review activity and claim status
  • Proactive updates on industry review and denial trends

We Have You Covered

Additional Solutions

Hive-Mentality

Patient-Centered

Quality Solutions