Quality, Accuracy & Compliance Review
Ensuring excellence in healthcare services and processes
Quality, Accuracy & Compliance Review
Our team examines medical claims data to identify potential fraud, waste and abuse.
RELI Group’s Quality, Accuracy & Compliance Review team examines the work of contractors that coordinate claims and billing for our public health services. Using an in-house team of medical experts, we examine medical coding, billing and recovery efforts to detect patterns – from simple errors to criminal fraud.
OUR SERVICES
What can the Quality, Accuracy & Compliance Review team do for you?
Medical Claims & Record Review
Services include medical record coding, claims and appeal reviews. Our medical record coding services include ICD-9-CM/ICD-10-CM retrospective coding, CMS-HCC validation, DRG/CPT/HCPCS coding, initial/secondary RADV HCC validation, and external cause of injury coding.
Medical Record Intake, Document Management and Compliance
Services include intake and validation of medical records; intake, scanning and uploading of consumer, state, federal and manufacturer/retailer documents; coding product and incident data; and redaction of Personally Identifiable Information from investigative materials released to the public.
Risk Adjustment Data Validation
Services include medical record intake/validity reviews, coding reviews, operational analysis, QA/physician reviews, appeal reviews/support, and training to both CMS contractors and Medicare Advantage Organizations.
Medical Record and Case Management
Services include using a federally compliant medical review case management tool to process, store, facilitate transport of, and host/maintain federal information (including PHI/PII). RELI has an approved Authority To Operate for a Secure File Transfer Protocol data server to receive medical records/documentation and maintain medical record review, audit/validation, and consumer complaint processes.
Quality Assurance Review and Monitoring
Services include reviewing emergency room reports and consumer injury data to confirm the accuracy of the data submitted by hospitals. We send error messages, purge Protected Health Information/Personally Identifiable Information from cases, and code additional variables such as mechanism of injury to the cases.
WHY RELI
What separates us from the rest
Medical Knowledge
Our subject-matter experts have been working in the industry for decades, both as clinicians and as medical billing and coding experts.
Proven Processes
Through successful contracts, we’ve established sound processes that ensure a high level of quality.
Experience
We have team members that have been on the same contracts since they were in the pilot phase.
Resources
Our large staff of nurses, physicians, medical coders and more means we have the staff to quickly address any new work.