Medical Review Services

Medical Reviews and Complex Clinical Claim Audits
Prepay. Postpay. Appeals. Investigative Coding and Billing, Overpayment Calculation, Fraud Identification

Medical Reviews
HCRG specializes in High Cost and Complex Medical Reviews and Claims Audits. Complex claims are the biggest drivers of healthcare costs. Medical reviews to confirm data analytics is critical before appropriate SIU actions are taken. HCRG brings to clients the added advantage of Specialty Medical Review and Complex Clinical audits. We expertly address costly claim drivers for high-cost services through an integrated strategy driven by proprietary methodology, advanced billing, coding and service algorithms. This is accompanied by an intense clinical audit by a group of multiple professionals who work together to produce the best in class investigative medical reviews. We formulate recommendations to address the significant findings

Types of Specialty Reviews
HCRG has the credentials, expertise and competence to handle all types of reviews. These include:
• Prepay • Postpay               
• Appeals • Investigative / Compliance

Complex High Cost Claims Audits
Complex services is where cost happens. Complex claims have to be audited for accuracy and appropriateness. HCRG audits pick up where data analytics leave off and utilizing proprietary methodology combined with expert hands on insight we identify billing and coding accuracy, documentation adequateness, care management appropriateness, use of service appropriateness, patient safety evaluation, quality of care evaluation, and evidence of fraud and abuse.

Focused Areas of Specialty
EM Codes
SNF
Sober Homes
UDT Lab
Specialized Medications / Cancer Blood Tests
PCS
Radiology Tests
Ambulance / Air Transport
Wound Care
Pain Management Intervention
Renal Dialysis
Dental
Ob/GYN
Telehealth more...

We stand by our work and we are able to provide expert witness if required.  


Customer Service
Call:  (562)-945-7224

Corporate Address:  
6571 Altura Blvd.,
Buena Park, CA 90620

“HCRG has Hearing Representatives active at all WCAB Courts in California.”