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Our team of RAC certified specialists offer guidance on the following:

  • System implementation to reduce and prevent denials

  • Management of MAC diagnosis edit denials

  • Management of documentation requests

  • ADR packet preparation, organization and submission

  • Management of appeals

  • Pre and post-payment probe review and UPIC guidance

  • Monthly reporting of your medical review activity and claim status

  • Proactive updates on industry denial trends

Medical Review & Clinical Compliance

QRM offers comprehensive medical review services with emphasis on process development, management strategies and risk mitigation.

We are experts in MAC, RAC, UPIC, CERT, and TPE levels of review.

QRM can optimize your Medicare, Medicaid, and Managed Care reimbursement opportunities through onsite and offsite coding, billing, clinical documentation education, and analysis. We offer establishment and review of internal billing and documentation process and focus on recovery of lost revenue.


Why should a provider invest in designated medical review personnel (e.g., historically, this has been managed by individual departments addressing their contribution area)?
Our experienced medical review team provides:

  • Billing analysis to identify required supporting clinical documentation, ensuring all submission components are incorporated into requests

  • Continuity and consistency for the achievement of successful medical review outcomes

  • Efficient and effective management of medical review activity, freeing providers from the burden of a potentially cumbersome, expensive, and time-consuming process

How can QRM Medical Review enhance our facility process?

  • By providing education/training to key facility personnel

  • Through the provision of organizational/management strategies for systematic medical review submissions of the highest quality

  • Through skilled identification of risk areas to eliminate the potential of surprise findings

What are the advantages of involving QRM Medical Review as an additional service offering?

  • Success rate with TPE management

  • Established rapport and familiarity with review contractors across all MACs and payor types

  • Timely management and control of the medical review process for the preservation of cash flow