Health Services


Health Services

Medical Claims & Record Review

Successful performance in the collection of beneficiary healthcare data through medical record review, having processed over 150,000 medical record reviews and over 10,000 claims reviews for CMS, as well as processing over 900,000 injury cases and documents for CPSC. Our team successfully and efficiently assigns ICD-9-CM codes that map to CMS Hierarchical Condition Category (CMS-HCCs) medical records in accordance with risk adjustment data validation policy and ICD-9-CM Official Guidelines for Coding and Reporting.

Data Analytics & Policy Research

RELI experts and PhD level resources perform policy and program review, identify vulnerabilities and risks, develop algorithms for possible fraud models, and perform data analytics and report generation using SAS, STATA and R. We help our clients gather and analyze data to improve decision-making and performance across organizations. We use proven methods and industry-leading tools to collect and examine structured data, producing predictive models to inform the client where the organization is headed. Clients equipped with this knowledge can then make strategic decisions for every aspect of the organization. Our services include, but are not limited to, predictive analytics and data mining, improper payment prevention and fraud detection, performance management and dashboards, business intelligence reporting, data profiling, and integration and quality services.

Public Health Research

RELI is uniquely positioned to close the gap between academic and Federal health research, facilitating a more open exchange of best practices for discovering and analyzing health information. We are proud to partner with Johns Hopkins, Penn State, and Morgan State faculties to offer research services that address the root causes of today’s public health problems. We also collaborate with a wide range of organizations from the communities that we serve. Our team of researchers conduct interdisciplinary research into the determinants of chronic disease and help develop community-based prevention strategies, multidisciplinary research into critical health policy, payment accuracy, and healthcare delivery issues.

Health Services Research

The main goals of health services research are identifying the most effective ways to organize, manage, finance, and deliver high-quality care; reducing medical errors; reducing improper payments; improving patient safety; and reducing inconsistency of the diagnosis coding practices. RELI Group’s consultants are experts in health services research, with interests organized around specific content areas. Our consultants are trained in health economics and health service research. Our expertise is in the development, management, and analysis of health services data with an emphasis on predictive modeling and risk adjustment methods. Two fundamental approaches we use to develop risk adjustment models are the categorical model and the regression model. We specialize in risk adjustment methodology to perform estimates for Medicare payment accuracy rates and Medicare Part C and Part D payment data validation. Our consultants are certified SAS programmers and PhD degree holders in their fields of expertise.

Digital Content Management

We support the collection, management, and publishing of our clients’ digital content, including day-to-day website and social media updates, and strategic content management projects, such as content migration and information architecture.

Digital Strategy Support

We use industry best practices, a deep understanding of the Digital Government Strategy, and a team of in-house human-centered design experts to ensure you connect your users to government information securely, anywhere, anytime, on any device.

Document Review and Management

In support of the Consumer Product Safety Commission (CPSC), RELI performs quality control reviews and coding of electronic records received in the National Electronic Injury Surveillance System. The results of our data review and collection support CPSC in their mission to protect the public using this data for policy and decision making, public awareness and education, and monitoring and enforcing statutes, standards, and regulation. The data also supports the CDC in their All Injury Program. We also perform document management for CPSC, including digitizing, electronically filing, coding and tabulating data, and redacting where necessary documents and data from product injury/hazard/death reports, consumer reporting sources, retailers/manufacturers, and state agencies.

Communication and Quality Control

RELI supports the Medicare Part C Improper Payment Measure National Risk Adjustment Data Validation (RADV) contract for CMS which includes drafting and issuing communications to Medicare Advantage Organizations on behalf of CMS, as well as review and quality control of internal and external audit documentation.