HCRG is an expert level organization providing services related to the management of healthcare costs.
HCRG specializes in evidence based investigative Medical Reviews of all specialties and high cost complex claims audits. We expertly conduct the reviews through an integrated strategy driven by proprietary methodologies advanced billing and coding analysis, clinical documentation, compliance guidelines, rules and regulations. When necessary peer to peer clinical audit is provided. The medical review team works together to produce best in class evidence based reports with recommendations to address significant findings.
HCRG is fully equipped to work alongside the SIU team to assist them in investigating the allegations of fraud, litigating the case and recouping money due to the payer.
HCRG is an expert provider of solutions to prevent, mitigate and fight FWA. Utilizing claims data analytics, Medicare, Medicaid, payer rules, cpt code analytics, medical evidence based criteria and business entity business management intelligence, we engineer our solutions to detect fraud patterns, abusive billing practices, over utilization and misrepresentation services. We work with payer organizations to identify, manage and prevent fraud.
Successful, accurate and evidence based medical review depends on the correct organization preparation and alignment of medical records. Organization of medical records is very expensive if not managed correctly. HCRG utilized its proprietary work procedure to quickly and efficiently prepare streamlined medical record so that reviewers are able to quickly go through the records and complete the preparation of the records.
HCRG have been an accredited provider of Continuing Education since 1988. For the last 20 years, we have been developing and presenting educational sessions nationwide for a multitude of healthcare professionals responsible for medical cost management.
HCRG have been the trusted consultants to some of the leading healthcare systems in North America, and provided them with distinctive, lasting and substantial improvements in performance affecting the bottom line.