Corporate Integrity Agreement (CIA) Support
EdiPhy Advisors provides independent review of medical
necessity determinations to assist providers who are operating under a
Corporate Integrity Agreement. EdiPhy Advisors is URAC-accredited as an
Independent Review Organization and employs physician advisors who
maintain relevancy and accuracy with the changing landscape of legal and
regulatory requirements in healthcare compliance.
As a URAC-accredited Independent Review Organization, EdiPhy Advisors
is committed to providing a fair and impartial medical peer review
process. The URAC accreditation process is designed to assure that
Independent Review Organizations are free from conflicts of interest,
establish qualifications for each physician performing independent
medical peer review, address medical necessity issues, are transparent
in their processes and have reasonable time periods for standard and
expedited peer reviews and appeals processes.
To support compliance with Corporate Integrity Agreements, the use of
EdiPhy Advisor’s IRO Services enables clients to reduce their liability
through the unbiased expertise of independent, Board Certified
Specialists and Subspecialists.
This service is critical for providers who are operating under a CIA.
Claims Review for Discovery Sample (and Full Sample if needed).
Annual Reports as required by the Office of Inspector General (OIG).
EdiPhy Advisors understands and is experienced with the requirements
of Claims Review, reporting of overpayments and annual reporting
requirements. EdiPhy Advisors uses appropriate statistical software to
select the Discovery Sample and Full Sample (when needed).
EdiPhy Advisors completes the Claims Review report per required
claims review methodology, statistical sampling documentation, and the
claims review findings (to include both narrative and quantitative
results). EdiPhy Advisors staff possess a clear understanding of the
requirements and deliver thorough reviews and analysis in order to
accurately complete the reviews and reports.