Audit and Recovery

Amenity’s Impressive Industry Knowledge affords a wealth of experience with all institutional, professional, and ancillary providers. We are familiar with nuances of federal, state, and commercial health plan claim processing, benefit design and coverage, medical policy, contracting, and program integrity efforts. We have a comprehensive understanding of various Payment Methodologies such as DRG, APC, ASC, per diem, fee schedule or percent of charge. Amenity uses established pricing tools and is deeply skilled in the ability to create algorithms and implement models.

The differences in Medicare, Medicaid and Commercial Plans require a unique way of regulations application and FWA identification.  We have worked with Managed Care Plans in many states including, Pennsylvania, Ohio, Virginia, Illinois, Michigan, District of Columbia (DC), South Carolina, Florida, Kentucky and Iowa. With deep experience in the provider institutional and provider environments & sectors, we understand how providers operate, think and perceive inquiries.  This allows our approach to consider these sensitivities while accomplishing identified goals in the various payment methodologies.  Whether it is a DRG methodology, APC, ASC, per diem, fee schedule or percent of charge, we have the ability to apply and execute the appropriate policies within a dynamic environment to review for medical coding and billing to correct coding and billing and enforce in each Line of Business.  We understand these dynamics and are accustomed to policy application and provider education needs across the spectrum.