Independent Review Organization

Customers particularly value our work as an Independent Review Organization (IRO).

IRO services include:

  1. Appealing denials/rejections from third party payers
  2. Developing a response to take-backs and recoupment proposed by government or other payers
  3. Defending providers in payer audits
  4. Providing oversight, review, and compliance reporting to the Office of Inspector General on behalf of providers subject to a Corporate Integrity Agreement.

The above services rely upon the capabilities of our credentialed staff in determining applicable standards and applying these standards to various clinical services. This may include review of documentation, analysis of CPT and diagnostic codes, review of payer contracts, summarizing guidance from CPT Assistant, reviewing Correct Coding Initiative edits, identifying Medicare Local Coverage Determinations as well as Medicare national policy, and peer group analysis.

Medical Billing Dayton Ohio

Why Choose Healthcare Claims Solutions, Inc.

Medical Billing Physician Billing

Healthcare Claim Solutions, Inc.

Helps physicians and health care organizations understand and improve their revenue management.

The health of your practice is a major concern to you…and for over twenty years has been our priority as well.

HCS provides an array of services built around fee-for-service reimbursement in either independent or hospital-based clinical environments.