Revenue Integrity Advisory Services for Healthcare Organizations

Why You Need Revenue Integrity Management Services

Deliver Fast, Accurate Responses to Every Audit and Investigation

Healthcare organizations routinely receive information requests from law enforcement and regulatory agencies. From standard claims monitoring and Medicare audits to fraud investigations by the Department of Justice (DOJ), timely and comprehensive responses are essential to accelerate the process and protect your organization. 

Strategic Management Services helps you develop and implement a response team to take immediate action on critical government inquiries. Our aim is to lighten your administrative burden and reduce the likelihood of a larger government investigation or audit, penalties, or criminal sanctions. 

How it Works

Take the Stress Out of Government Requests

• Response Preparation
  Our experts ensure your responses run like clockwork, with quick and consistent responses that meet the scope of inquiry, including:  
  • Conducting mock audits and statistically valid probe audits to decrease the likelihood of missteps during critical response time 
  • Advising adjustments to existing protocols to fortify response and defense in government inquiries 
• Request Analysis 
  Our team of certified coders and nurse auditors helps you understand and evaluate requests, including: 
  • Initial assessments of government inquiries 
  • Statistical sampling methodology evaluation 
  • Recovery demand assessments for compliance with established review standards 
  • Analysis of confidence and precision intervals in overpayment estimates 
  • Review of findings from CMS contractors (RACs, MICs, ZPICs) 
  • Analysis of state Medicaid audit and investigation unit findings 
  • DOJ findings analysis and evaluation
• Litigation Support
  Our experts can work under the direction of legal counsel to assist in the defense of health care organizations subject to demand letters from government agencies, including:  
  • Assisting legal counsel to provide supporting and critical examination of the organization’s claims data in preparation for legal action 
  • Acting as an expert witness on behalf of the health care provider or supplier. 
  • Providing strategic and tactical support when our clients come under scrutiny by government agencies and their contractors. 

Certified Adherence to Government Standards

Strategic Management follows industry-leading standards for all claims reviews and audits, including medical review best practices and application of OIG RAT-STATS. 

We certify that all statistical analyses, claims reviews, and evaluations meet the Government Accountability Office’s Generally Accepted Government Audit Standards (GAGAS) for independence and objectivity. 

Our approach includes an objective, systematic examination of claims against regulatory and government program criteria. Every team member has the required professional expertise and operates free from conflicts that could compromise objectivity.