InterMedCorp is an approved independent review organization (IRO) with the office of inspector general (OIG). We can help physicians, practices and hospitals fulfill their corporate integrity agreement (CIA) requirements. We provide quality results at an affordable price.
Special Investigations
Medical review is an appropriate and necessary means by which to detect insurance claim overreaching and fraudulent activity. However, the medical review should be independent, fair and objective. The review should be conducted by qualified medical personnel who are capable of reviewing the results of diagnostic tests and rendering expert opinions. Results should be stated within a reasonable degree of medical certainty, concerning the nature and extent of claimant's injuries.
Appeals for utilization, quality, and facility code violations. We will review the medical records to determine grounds for appeal regarding findings related to utilization of medical services, quality of care issues, or other violations of federal law. If necessary InterMedCorp can represent clients in formal and informal appeals proceedings. InterMedCorp’s services are designed to detect, investigate and prevent health care fraud. We work on behalf of the insurance plan as an independent reviewer.
Medical Fraud covers topics such as Coverage issues, Legislation affecting fraud and abuse, CPT, ICD-9 and DRG coding guidelines.
Typical types of fraud behavior
UPCODING
A doctor performs one medical procedure and charges the insurer for another, more profitable (or permissible) one.
UNBUNDLING
The whole is sometimes worth less than the sum of its parts. A medical service broken down into its components--a procedure here, a service there--with a separate bill for each, can mean a significant profit.
Insurance companies pay out millions of dollars each year to fraudulent or inaccurate claims. Detection is the best way to control costs and quality of service.
Medical Record Review
A record review usually comprises three sections:
- Brief Summary or narrative overview.
- Discussion of pertinent issues that would appear to be impacting the case.
- Conclusion and recommendations for continued investigation and follow-up.
- Complete review as appropriate for complex cases having moderate to extensive records, multiple conditions and/or providers.
- Practitioner consultant opinion is optional.
- Discussions and consultations provide rationale and points of strength.
- Recommendations provide guidance for effective and continued investigations.
- A stand-alone chronology is also available.
Medical Literature Review
A literature review is a record review with references to research that substantiates recommendations and conclusions. It can also be conducted as a stand-alone request without a file review.
- Pertinent, reliable textbook and medical database research into conditions, procedures, and techniques.
- Research data can be submitted to a practitioner for medical opinion.
- Interpretation and summarization of literature findings can be provided.
- Literature search for articles by opposing medical expert can be provided.