Government Investigations

Investigations and Audits

 

Physician Practice Guidance provides audit support to physicians who are the subject of healthcare investigations and audits.

 

We provide chart reviews and audits of billed claims and remittance advices working with defense attorneys, in situations where physician billing is audited for medically unnecessary services or procedures, upcoding and other billing activity. Physician Practice Guidance has significant experience in the review of data to respond and defend against healthcare investigations and audits.

 

Additionally, Physician Practice Guidance provides internal audit services and the development of revenue cycle policies to ensure compliance with ICD 10 and CPT guidance, Federal and state law.

 

Audit services offered

  • Audits from CMS and Intermediaries
  • ZPIC audits or Unified Program Integrity Audits
  • Medicare Audits (RADV)
  • TPE audits
  • Medicaid Audits
  • Tricare Audits
  • Audits from private insurers, such as Blue Cross, Aetna, United Healthcare
  • Internal healthcare audits and compliance audits

 

We support all healthcare organizations of all specialties and services, including but not limited to:

 

  • Group practices and solo practitioners
  • ACOs
  • IPAs
  • Specialty networks