Design

Claim 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.

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Customized Analytical Solutions

Amenity Consulting and its team address cost recovery challenges via a comprehensive suite of audit services which covers a broad range of administrative accuracy, fraud-waste-abuse, and clinical analytics. These services can be selected individually or as a package. Amenity can help you address the following common issues:

  • Claims administration errors
  • Cost Containment
  • Escalating facility charges
  • Experimental & Investigational drugs & devices
  • Fraud, Waste & Abuse
  • Inaccurate coding
  • Inconsistent billing practices
  • Medical Necessity Audits
Options

Predictive Modeling

Amenity’s impressive industry coding knowledge affords a wealth of experience with all claim types. 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 payment methodologies such as DRG, MSDRG, APDRG, APRDRG, per diem, fee schedule or percent of charge. We have established pricing tools and have the deep experience creating algorithms, reverse engineering data and building models to mine for cost containment and recovery.

Why Choose Us

  • Amenity builds customized solutions for over-payment recovery
  • We reverse engineer your plan specific data for unique data modeling
  • Our investigators identify coding, claim submissions and schemes for fraud recovery
  • Our experts support interpretation and testimony during legal review and litigation at with law enforcement
  • Our Auditing and Reporting far exceed the basic prospective and retrospective industry options