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Case Management & Utilization Review

By definition: “Case Management is a collaborative process that assesses, plans, implements, coordinates, monitors, and evaluates the options and services required to meet an individual’s health needs, using communication and available resources to promote quality, cost-effective outcomes”.

At American Healthcare Audit Professionals we provide independent nurse Case Management services in a timely, efficient and professional manner for our clients. All of our experienced Nurse Case Managers have extensive clinical background in different areas of healthcare including critical care and worker’s compensation.

We provide our customized and comprehensive services for hospitals, medical providers, insurance companies, managed care providers, TPA, attorneys. Just to name a few

“Making a difference where it counts!”

Auditor's Corner

"There are many steps that inpatient hospital providers can take to avoid denial of their claims when submitting Medicare fee-for- service claims. The Centers for Medicare & Medicaid Services (CMS) discussed numerous findings uncovered by Recovery Audit Contractors during a March 9, 2011 podcast. To prevent future improper payment issues, CMS encouraged providers to understand the "lessons learned" listed below, take necessary steps to meet Medicare documentation requirements, and implement corrective actions." Read on

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    • Medical Chart Auditing/Hospital Bill Review
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