??Don’t wait for problems to arise—take control of your SIU’s performance today! ??Start building your own SIU scorecard with the right KPIs and benchmarks and begin tracking meaningful metrics that drive results. ??If you need help setting up your scorecard or analyzing your current performance, contact us to schedule a consultation with our experts. ??Together, we can enhance your SIU’s effectiveness and help you combat fraud with confidence. #KPIs #SIUScoreCard #SIUSuccess #AdvizeHealth
Advize
医院和医疗保健
Orlando，Florida 56,580 位关注者
Healthcare & IT Audit & Advisory, Program Integrity, Compliance and Consulting for Payers, Providers, Legal & Government
关于我们
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.
- 网站
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https://advizehealth.com
Advize的外部链接
- 所属行业
- 医院和医疗保健
- 规模
- 51-200 人
- 总部
- Orlando，Florida
- 类型
- 私人持股
- 创立
- 2003
- 领域
- Litigation Support、Medical Necessity、Record Collection、Claims Review、Healthcare、Claims、Healthcare Legal Support、Medical Records、Consulting、Expert Witness、HITRUST、FWA、OIG、CMS、UPIC、DRG、HCPCS、Arbitration、Audit、Advisory、Medical Record Audit、SIU、Compliance、Analytics、Federal、Healthcare Consulting、Expert Testimony、Hubzone、Women Owned、Government和CPC
地点
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主要
获取路线
US，Florida，Orlando
Advize员工
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Adam Labenow
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Jeanmarie Loria, MBA, PMP, CPC
CEO, Advize Health
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Brian Boyce
MHA, BSHS, CPC-I, CRC, Healthcare Operations Consultant & Auditor specializing in Risk Adjustment & Population Health
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Jaysen Eisengrein, MBA, PgC, SAC (RET)
Retired HHS OIG Special Agent in Charge/Advize Health Special Director in Charge/FWA Consultant
动态
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??Would you do this? ??How do we balance financial sustainability with ethical patient care? We see this tension daily. Automation and payer policies are shifting the landscape—sometimes at the cost of those who need care the most. Program integrity shouldn’t mean denying rightful claims; it should mean ensuring fair, necessary, and ethical healthcare practices. What do you think? Have you seen similar cases? ?? Let’s talk about the real impact of payer decisions. https://lnkd.in/eQtrNUZq #Healthcare #Insurance #PatientCare #EthicalMedicine #ProgramIntegrity
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??We’re Watching—And So Should You. ????The healthcare industry is shifting. ??More people are speaking out. More patients are demanding answers. But change doesn’t happen overnight. ??We’re committed to calling out broken systems—whether it’s fraud in billing or fraud in patient care. Because at the end of the day, healthcare should heal, not harm. ??Have you experienced medical gaslighting? We want to hear your story. Share in the comments or send us a message. It’s time to hold the system accountable.
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??OIG Roundtable 119: The Medicare Policies Shaping Commercial Payors—Like It or Not Medicare policies don’t just stay in their lane. As CMS rolls out new National and Local Coverage Determinations (NCDs and LCDs), commercial payors are increasingly being influenced—sometimes in ways they never anticipated. These regulations are shifting reimbursement models, altering compliance expectations, and blurring the lines between government and private insurance. In this episode, Eric Rubenstein, MSCJ, CFE, Wade McFaul, and Matt Kochanski break down the direct and indirect ways CMS regulations are reshaping the commercial payor space. From unexpected policy overlaps to the long-term impact on fraud investigations, this discussion unpacks what industry professionals need to know to stay ahead. https://lnkd.in/emEiUyig #HealthcareFraud #SIU #MedicarePolicies #CMSRegulations #CommercialPayors #HealthcareCompliance #InsuranceIndustry #FraudPrevention #HealthcareInvestigations #PolicyImpact #MedicalBilling #ReimbursementRules #ProgramIntegrity
OIG Roundtable 119: When do Medicare Policies Affect Commercial Payors
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??THESE CODING MISTAKES ARE COSTING YOU THOUSANDS! Are you unknowingly throwing money away? One simple mistake in DME or Chronic Care Management (CCM) coding can lead to denied claims, audits, and even fines. ??The most painful mistakes you might be making right now: - Using time-based CPT codes incorrectly → If your documentation doesn’t prove the time spent, kiss that reimbursement goodbye. - Failing to meet DME documentation requirements → Without airtight records, your claims WILL be rejected. - Unbundling or overcoding services → This can trigger fraud investigations (yes, even if it was unintentional). - Missing required signatures or provider attestations → No signature? No payment. - Billing for services that lack medical necessity → One flagged claim could mean a full-blown audit of your entire practice. - Ignoring state, federal, and payer-specific policies → The rules are changing in 2025. Are you prepared? If any of these sound familiar, you NEED to attend this webinar. What You’ll Learn: ? How to fix these errors before they catch up to you. ? Compliance strategies to protect your revenue and reputation. ? What OIG, CMS, and MACs are cracking down on in 2025. Don’t wait until it’s too late—your revenue is at stake. Date: Tue (3/25) | 1 PM ET Register Now: https://lnkd.in/ghwXUNse Speakers: Carey Mead | Mandi Berg #MarchWebinar #MedicalBillingMistakes #DeniedClaims #HealthcareCompliance #DME #CCM #BillingErrors
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??Optimize Your Compliance & Program Integrity with Advize! Managing SIU and Payment Integrity challenges while controlling costs is no easy task. We help healthcare organizations streamline operations, eliminate inefficiencies, and maximize ROI with expert-led consulting and advisory services. - Identify & Reduce Duplicative Efforts - Enhance Collaboration Across Departments - Improve Provider Education & Reduce Abrasion - Optimize Compliance & Fraud Prevention Strategies - Achieve Faster Overpayment Recovery With our scorecard assessment and DMAIC methodology, we deliver measurable improvements that drive efficiency and savings. Our team of highly qualified investigators, auditors, and compliance experts is ready to support your organization’s success. Let’s build a stronger compliance strategy together! Contact us today. ?? [email protected] #HealthcareCompliance #SIU #PaymentIntegrity #FraudPrevention #AdvizeHealth
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?? Have you ever been told your life would never be the same again? ?? That you'd never live as you once did? ?? What if the first opinion you hear isn’t the final truth? From being told you’ll never walk again after a simple injury to facing terminal illness with no options left, extreme diagnoses can be devastating—but they’re not always the last word. Misinformation runs rampant—even from the professionals we trust. That’s why it’s crucial to question, seek alternatives, and advocate for the care you deserve. In this blog, we’ll explore how to take control of your health journey, challenge the system, and make decisions that truly benefit you.
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?? How to Avoid Phishing Scams ?? By Erik Consorsha | Advize's Chief Information Officer Another day, another phishing attempt—but luckily, we dodged the scam! Now, we’re sharing our best strategies so you can stay one step ahead. Stay sharp, spot the red flags, and don’t let scammers reel you in! ????
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