Medical Review Services to Strengthen Compliance and Reduce Improper Payments
IntegrityM delivers independent, clinically driven medical review services that help public and private payers detect improper payments, verify documentation, and strengthen program compliance. Our reviews are grounded in clinical expertise, regulatory knowledge, and audit readiness best practices.
End-to-End Medical Review Capabilities
IntegrityM delivers comprehensive medical review services that help identify improper payments, ensure documentation accuracy, and support compliance with CMS, Medicaid, Medicare, and commercial payer requirements. Our specialists assess claims for medical necessity, coding accuracy, and alignment with applicable policies and guidelines.
Key Areas of Medical Expertise
Our medical review experts assess a wide range of factors, from clinical documentation to coding accuracy and provider behavior.
- Pre- and post-payment claims review
- Medical necessity and clinical documentation audits
- Detection of billing outliers and anomalies
- Provider education and engagement strategies
- Medicaid and Medicare compliance alignment
- Reviews for fee-for-service and managed care programs
Reducing Improper Payments
IntegrityM works with agencies and payers to reduce improper payments by combining clinical expertise with data-driven audit methodologies.
- CPT/HCPCS coding analysis to uncover claim-level inaccuracies
- Identification of billing discrepancies and overutilization trends
- Detection of patterns associated with potential patient harm
- Pre-payment and post-payment audits with clear, defensible reporting
- Support financial recovery efforts through defensible findings
Medical Necessity & Documentation Review
Our team evaluates whether billed services are medically necessary, accurately coded, and properly documented according to payer guidelines.
- Verifying that documentation clearly supports billed services
- Ensuring services are reasonable, necessary, and covered
- Alignment with National and Local Coverage Determinations (NCD/LCD)
- Safeguarding against falsification or alteration of medical records
How We Support Oversight for Government and Health Plans
IntegrityM partners with oversight entities to bring clarity, structure, and defensibility to medical review activities for federal, state, and private programs.
- Strengthen audit and review protocols
- Integrate with fraud, waste & abuse prevention
- Deliver audit-ready documentation & verification
- Support quality improvement strategy integration
Schedule a Consultation
Partner with IntegrityM to strengthen your medical review and payment integrity programs.
Schedule a Consultation
