Expert Services for Every Stage of Your Revenue Cycle

As AI coding tools enter your workflow, you need a human expert to validate output, catch errors, and defend decisions before claims are submitted.

Proactive compliance audits, coding policy development, and regulatory guidance to keep your organization protected and properly reimbursed.

• Prospective and retrospective coding audits
• Payer-specific audit preparation and response
• Coding policy development and compliance program support

Coder and provider education tailored to your specialty. Online training that keeps your team current with the latest coding guidelines and payer expectations.

• Design of audit frequency, volume, and target audience, whether provider, coder, auditor, or both
• Error recognition training for providers, coders, and internal auditors
• Auditor education covering audit methodology, sampling techniques, and documentation of findings

When a payer dispute moves to litigation or arbitration, credibility wins cases. Edelberg has provided expert witness testimony in proceedings against major national payers, with a track record that speaks for itself.

• Payer dispute litigation involving claim denials, downcoding, or systematic underpayment
• Arbitration and mediation proceedings with insurers to support accurate coding and educate payers on coding rules grounded in established coding principles
• False Claims Act investigations and government audit matters involving coding practices