Practice Masters, Inc. is headquartered in Western Pennsylvania and provides expert analysis and testimony related to civil or criminal post payment matters on behalf of legal counsel representing Medical, Physical Therapy and Chiropractic providers in private and group practice.
PMI only uses appropriately certified coding and auditing experts as well as licensed providers with similar coding and auditing training where medical necessity is the basis for denial.
PMI’s forensic auditors follow the audit protocol recommended by the HHS OIG to ensure accurate and defensible audit results. Only with a clear understanding of applicable criteria can an accurate audit result be obtained. Many auditors fail to apply appropriate criteria and their findings are erroneous as a result. While the HIPAA mandated Transaction and Codeset Standards created a uniform list of procedure codes and descriptions (as listed in the AMA CPT-4 Coding Manual) for all covered entities, there are no standard rules for how codes should be utilized. We will search the relevant statute, regulation or carrier policy fully to find the relevant criteria and where none is expressed, we will support conclusions with reference to credible persuasive authority.
PMI also has significant experience evaluating the propriety of statistical methods used in determining the error rate and overall recovery amount. We have a well qualified (PhD) statistician on our team that will analyze the statistical methodology to identify erroneous assumptions or conclusions. While the concept of statistical modeling is valid, there is a strict mathematical process which is dependent on a number of assumptions which must be valid. Where the assumptions are invalid or there is deviation from the statistical process, the result may be invalid. Our statistician is experienced in identifying, disclosing and explaining these errors as part of rebuttal analysis.
To review the issues in a pending matter, feel free to contact us at: (814) 754-1550. We look forward to assisting you.
With kind regards,
Michael D. Miscoe jd,d, CPC, CASCC, CUC, CCPC, CPCO, CHCC