Medical Denials &Appeals Expert has been offering Denials and Appeals Management Services to major hospitals and third party appeals contractors in New York and Maryland for over 6 years. Over 7000 Medical Necessity and Coding/DRG Validation appeals have been successfully appealed in response to both Government-Medicare & Medicaid-and commercial-Blue Cross, Aetna, Health First, HIP, etc., denials for our clients. Our team of experts in appeals and medical necessity reviews include MDs, PAs, RNs and FMG (ECFMG certified) with over 15 years of utilization management and appeal writing experience.
Our services include:
Medical Necessity Review: This process involves reviewing patients’ clinical documentations to justify medical necessity for inpatient level of care. This review include : Pre-admission medical necessity review of patients’ medical records to justify inpatient level of care prior to admission from the ED, ambulatory services, outpatient clinics etc; Continued stay medical necessity reviews are done while the patients are still is admitted to justify inpatient stay. Post discharge reviews are done after the patient is discharged and prior to billing or submission of claims to the payers.
Medical Necessity Appeals – At Medical Denials and Appeals Expert, we write medical necessity appeals in response to medical necessity denials from all healthcare payers for our clients. We write all levels of Medical Necessity Appeals (level 1, 2 and 3-coordination of Medicare ALJ Hearings). Our appeal writers include RNs, PAs, MDs, etc, with more than 15 years experience in appeals and utilization management.
Coding/DRG Validation: We appeal all your coding denials for you. Our appeal writers are Certified Coding Specialist (CCS) and Documentation Improvement Practitioners (CDIP) with many years of coding/ DRG validation.
Clinical Documentation Improvement Services: Let our Clinical Documentation Improvement Specialists review your patients’ medical records before submitting your claims.
Our team works in a secured and HIPAA compliant environment, and understands the importance of keeping patient’s information secure and private.
Interested clients can either visit our website to register and complete the service request form or call us @ 973 285 3042
Yes, we offer medical coding and billing services to hospitals, physician offices, Laboratory, physical therapy & diagnostic centers. Our services are competitively priced, cheaper than hiring your owns staff. Claims are processed timely and electronically. We also mail paper claims when required.
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