Four steps, one standard: everything we assert, we can source.
We work alongside healthcare attorneys to ensure your audit meets the legal requirement to rebuttal. The method is fixed so the findings are reproducible: your counsel receives the same artifacts every time, in the same order.
Intake
The allegation letter, the sample, and the extrapolation method. We start where the payer started.
Extraction
Full claims, remittance, and documentation data for the audit period, the whole population, not the sample.
Analysis
Line-by-line review against coding rules and clinical documentation, with every determination sourced.
Rebuttal
A cited findings packet your counsel can file, plus expert support through appeal.
Sixty days, typical
This is an average. An engagement can run shorter or longer depending on the matter type.
What a findings packet looks like
An anonymized extract from a commercial payer matter. Every determination links to its source document.
| Claim | Code | Description | Determination | Basis | Source document |
|---|---|---|---|---|---|
| CLM-0093-221 | 99285 | Emergency, level 5 | Supported | Documentation supports acuity | Open the source document |
| CLM-0093-244 | 99284 | Emergency, level 4 | Supported | Time and MDM documented | Open the source document |
| CLM-0094-018 | 99215 | Office, established | In review | Awaiting provider note | Open the source document |
| CLM-0094-102 | J18.9 | Pneumonia, unspecified | Supported | Radiology corroborates | Open the source document |
| CLM-0094-311 | 99223 | Inpatient admit | Disputed | Payer cites missing history | Open the source document |
| CLM-0095-007 | 99291 | Critical care, 30–74 min | Supported | Duration recorded in flowsheet | Open the source document |
The payer’s sample
40 claims, drawn from a 2021–2023 population of 1,412,908 lines, projected to a $23.1M demand.
What the population shows
Error rate in the full cited set is 3.6%, not the 27% the sample implies. The projection does not survive the wider record.
The strongest rebuttal is a record that was already in order.
Defending an allegation is where we start, not where we stop. We help you put your compliance requirements into practice and keep them there, holding the record to the same standard before a payer asks as we would after.
OIG compliance program
The seven elements: written policies, a named compliance officer, training, reporting channels, auditing, enforcement, and corrective action. We help you stand each one up and evidence that it operates.
HIPAA privacy and security
Risk analysis, administrative and technical safeguards, workforce training, business associate agreements, and breach notification procedures your team can follow without a consultant in the room.
Coding and billing accuracy
Documentation standards and an internal review cadence, so coding and medical necessity hold up on their own terms long before a payer asks about them.
Payer contract obligations
Timely filing rules, audit-response duties, and reporting requirements, tracked contract by contract so every obligation has an owner and a date.
Implementation is one day. Monitoring is every day after.
We set the review cadence with your team and run it alongside them, keeping the documentation current so what you attest to is what the record shows. You stay the owner of your program. We make it provable.