Healthcare Claims Auditing & Monitoring

Auditing and monitoring the claims development and submission process is critical for any health care organization. Through effective claims auditing and monitoring, health care organizations can identify risk, and implement controls to manage these risks. Strategic Management employs a systemic approach to auditing and monitoring that is tailored to the uniqueness of each organization we work with.

Health Care Claims Audit

Strategic Management’s team of health care consultants conduct claims auditing services, including annual and high-risk audits, resolution of audit findings and implementation of a work plan and corrective action. We examine and evaluate the adequacy and effectiveness of internal controls, systems and policies, and compliance with applicable laws, rules and regulations.  The identification of deficiencies is critical for health care organizations to avoid overpayments and potential inquiries from government auditors. 

Health Care Claims Monitoring

It is essential for health care organizations to implement on-going monitoring of the claims development and submission process and system. However, many organizations lack the expertise or resources necessary to develop and implement effective monitoring procedures. Strategic Management’s team of health care consultants examine audit findings and assist health care organizations with developing and implementing proper controls and monitoring procedures to ensure sustainable compliance with health care laws and program billing rules.