Our Corporate Credentials
Our staff of licensed and credentialed Coders, Nurses, Health Information Management Professionals, Case Management/Utilization Review, and Business Analysts work hand in hand to ensure cost containment, education and solid claim identifications that lead to recoveries exceeding our clients’ expectations. Amenity’s knowledge of various payment methodologies and pricing structure is exceptional, allowing us to proficiently perform audits of nearly all claims types and reimbursement methodologies. As industry renowned subject matter experts, we understand the many facets of the revenue cycle and, billing and coding operations that contribute to fraud, waste and abuse. Amenity also brings deep experience in the provider sector that allows insight into behaviors that result in waste and abuse. We use this expertise to harvest significant findings of superior quality distinction when performed in conjunction with internal data characterization processes far exceeding the yields derived by industry norm attributes of data plug and play results.
Our Superior Skills
Our Experts
Subject Matter Experts
We offer the following Subject Matter Expertise Proficiencies and Services:
• Identification and Resolution of Escalating Facility Costs
• Model Contract and Contracting Methodologies
• Contract, Pricing and Claims Payment Compliance
• Fraud – Waste – Abuse (FWA) Investigations
• DRG Audits (MS, AP, APR)
• Expert Coding and Billing Testimony
• Best-in-Class Audit and Provider Policy Support, including identification of Experimental and Investigational Drugs and Devices
• Internal and Compliance Audits
• Clinical Documentation Improvement and Coding Capture for various Data Reporting Initiatives ICD-10 Implementation Support
• Encounter Data Accuracy and Capture
• Identification and Resolution of Escalating Facility Costs
• Model Contract and Contracting MethodologiesSpecialty Physician Advisor Support
Expert Witnesses
Amenity and its CEO currently and have historically provided extensive support to Healthcare Fraud and False Claims Act investigations resulting from federal and state teams to include investigations resulting from Health Care Fraud Prevention and Enforcement Action Team (HEAT) efforts. Our staff have acted in the capacity of Litigative Consultant and Opinion Witness to law enforcement including the Department of Justice (DOJ) in Washington, DC and nineteen (19) US Attorney/OIG-HHS Offices in sixteen (16) states. Amenity has been requested to provide subject matter expertise to Qui Tam attorneys in cases where the government has intervened and civil cases where they have not. Our subject matter experts have an established reputation in the areas of Medical Coding and Billing, Health Information Management, Utilization Review, Medical Necessity and Medical Review activities. Our credentials include Certified Coders, Fraud Investigators, Registered Nurses and Specialty Physicians.
At the state level, Amenity works/has worked with Medicaid Fraud Control Units (MFCU) and related departments in conjunction with active law enforcement investigations. We are well versed in Medicaid payment methodologies and program integrity enforcement based on state policies.
Amenity and its staff have worked along the full spectrum of litigation including Investigation, Documentation Review, Data Analysis, Opinion Reports, Hearings, Depositions, Settlement Conferences and Criminal Trial.
We have worked alongside the country’s finest program integrity efforts including Zone Program Integrity Contractors (ZPIC), Program Safeguard Contractors (PSC) and Medicaid Integrity Contractors (MIC). We are committed to supporting protection of the Trust Fund by lending our expertise to the efforts against leakage from waste/abuse and healthcare fraud.
Credentialed Auditors
Amenity Consulting has decades of experience in correct claims auditing. Our mission is to deliver the most comprehensive and adaptable audit program available in the industry. Our Audit Program delivers best-in-class results for your scope of work using our highly credentialed expert team and holistic approach to payment accuracy review and audits. The knowledge, tools, and techniques that we employ drive an unparalleled record of delivering exceptional value and returns to our clients.