#July Webinar 🚨 🧪Navigating Laboratory Schemes: Trends, Red Flags, and Best Practices. Please join us for another exciting webinar to discuss the ever-evolving world of lab schemes. Our presenters Lera Champagne-Andriani and Mandi Berg will walk you through key policies, top schemes that affect this specialty, and share tips on working these cases, including red flags in the data, medical reviews and on-site visits. Additionally, we will hit on GLP-1 drugs (ex: Ozempic), common schemes and data mining tricks to capture fraud, waste and abuse. Be sure to mark your calendars 📅 We look forward to seeing you! #HealthcareFraud #HealthcareServices #PassThroughBilling #Modifiers #UrineDrugTesting #GeneticTesting #MolecularPathology #ProcedureCode81479 #SIU #FWA #HealthcareInnovation #Ozempic #LabSchemes
Advize
Hospitals and Health Care
Orlando, Florida 33,805 followers
Healthcare & IT Audit & Advisory, Program Integrity, Compliance and Consulting for Payers, Providers, Legal & Government
About us
After nearly two decades of auditing large data sets and performing extrapolation for increased ROI for payers, Advize has shifted focus to building relationships with providers based on data and best practices. Our team has expanded our model of coding and billing audits focused on waste and abuse to examine fraud through Big-4 Data Analytics and OIG best practices. Audit and Support Services – Record Retrieval, Storage, Purge – Onsite record retrieval – Send request letters and other communications with providers – Secure file upload (SFU) – Records are stored securely and discarded in accordance with HIPAA recommendations and requirements – Minimum necessary PHI accessed – Record files are securely returned with audit result delivery – Corporate Integrity Agreements – Statistically valid sampling – Medical necessity and proper coding/documentation review – Audit Management and Quality Assurance Support – QA Review – Reporting and Results Delivery – Overpayment Recovery and Overpayment Support – Legal Support – Case building, expert witness, audit, reporting and testimony Review and Reporting – Reviews performed by highly experienced and credentialed auditors – Audit personnel work with a variety of healthcare personnel and patients. They should always conduct themselves in an acceptable, professional manner and adhere to ethical standards, confidentiality requirements, and objectivity. Auditors trained to completely document their findings and problems. – Perform verification of charges – What citations are important, and what policies are important? – Citation guidebook creation – Review of claims – Generation of preliminary audit results – Results delivery and collaboration with client – Report generation – Final Audit Results: – Contain final audit reporting, this reporting will have included the overpayment amount. – Review the next steps for the provider who was audited.
- Website
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https://advizehealth.com
External link for Advize
- Industry
- Hospitals and Health Care
- Company size
- 51-200 employees
- Headquarters
- Orlando, Florida
- Type
- Privately Held
- Founded
- 2003
- Specialties
- Litigation Support, Medical Necessity, Record Collection, Claims Review, Healthcare, Claims, Healthcare Legal Support, Medical Records, Consulting, Expert Witness, HITRUST, FWA, OIG, CMS, UPIC, DRG, HCPCS, Arbitration, Audit, Advisory, Medical Record Audit, SIU, Compliance, Analytics, Federal, Healthcare Consulting, Expert Testimony, Hubzone, Women Owned, Government, and CPC
Locations
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Primary
Orlando, Florida, US
Employees at Advize
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Jeanmarie Loria, MBA, PMP, CPC
CEO, Advize Health
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Brian Boyce
CEO, MHA, Risk Adjustment, Clinical Bioethics, Healthcare & Practice Operations Consultant. Aeromedical Air Force Vet, Entrepreneur, Human Rights…
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Jaysen Eisengrein, MBA, PgC, SAC (RET)
Retired HHS OIG Special Agent in Charge/Advize Health Special Director in Charge/FWA Consultant
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Robin L. Kessinger
RN, CPC
Updates
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⭐ Meet Dena B., Healthcare Consultant at Advize. Dena’s energy is positive, contagious, confident, and approachable, making her a standout member of our team. Driven by a passion for lifelong learning and a deep desire to help others, Dena has transitioned from a career as an RN to specializing in Fraud, Waste, and Abuse. We’re incredibly fortunate to have her expertise and enthusiasm guiding us toward meaningful change. Read her full story and discover how her skills are making a difference in our industry. - - - Why did you choose to work in healthcare? I chose a career in healthcare, specifically as an RN, to work in an environment that is ever-changing and full of learning opportunities. I have a strong desire to help others and embrace lifelong learning and the challenges of stepping outside my comfort zone. My career has evolved to include specialties in clinical, patient, and provider education, as well as pharmaceutical and specialty pharmacy sales support. In these roles, I specifically enjoyed the travel throughout the U.S., meeting people, and working within diverse communities. What is your current 'why' behind your decision to continue to work in this industry? When I grew tired of the road warrior lifestyle, I sought a new challenge, acquired my CPC, and entered the world of Fraud, Waste, and Abuse (FWA). This industry provides the spark that fulfills my natural curiosity and need for continued learning. I especially enjoy discovering the “why” and “how” behind the issues that the FWA industry addresses. #HealthcareConsultant #FraudPrevention #ValueBasedCare #FraudWasteAbuse #HealthcareHeroes #LifelongLearning #PatientCare #HealthcareSpecialist #HealthcareEducation #AdvizeHealth #HealthcareJourney
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🥇Inspired by our CEO's post Jeanmarie Loria, MBA, PMP, CPC: Today we celebrate the start of the Olympic Games! This reminds us that leadership is not just about talent; it's about relentless work, determination, and countless hours of practice and learning. Let's be inspired by the athletes who lead by example, showing us that true leadership shines through dedication and discipline. Our mantra for the upcoming weeks? Shine and inspire generations! Let this spirit guide us in every role we take on. Now, let JM know: - Which is your favorite: Summer or Winter Olympics? - What sports are you most excited to watch? - How do the athletes' dedication and discipline inspire you in your own leadership journey? For her, both seasons of the games are a source of inspiration, pushing her to work harder to achieve greatness. #OlympicGames #LeadershipInspiration #ShineAndInspire #Dedication #Discipline #AthleteMindset #SummerOrWinter #SportsInspiration #Greatness #LeadershipJourney #InspireGenerations #TeamSpirit #CelebrateExcellence #WorkHardPlayHard
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💡The OIG Roundtable: Episode 87: Deconfliction in the SIU Space Eric and Matt discuss the difficult topic of deconfliction of complaints and investigations in an environment that does not necessarily lend itself to collaboration. The discussion focuses on duplicative efforts, the role of a law enforcement liaison, and the importance of being able to trust your FWA partners. https://lnkd.in/gvPKEdRY
OIG Roundtable 87: Deconfliction in the #SIU Space
https://www.youtube.com/
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We are thrilled to celebrate our incredible intern, Brady Nevala, whose enthusiasm and unique perspective have brought so much to our team. Brady is a Criminal Justice major who has found joy in learning about the criminal justice system and law, even though he might not follow the traditional law enforcement route. His favorite college class? Capital Punishment – it was intriguing to dive deep into the history and intricacies of the death penalty. Brady's words sum up his experience with us perfectly: "This internship has been amazing. The people I’ve met and the things I’ve learned have been nothing but fun. It’s cool seeing how a company conducts its investigations and just how much goes into a single case. What I like most is how supportive everyone is. I feel like I’ve made genuine connections and can ask for help without worrying about being shut down. Knowing this is my first time with many things, the patience and guidance I’ve received have been fantastic. This has been a great experience so far, and I am looking forward to this next month of work." It's a privilege to witness Brady's professional growth and to be part of his journey. Here’s to nurturing the next generation of healthcare leaders! 💼🚀 #NationalInternDay #ThankYouInterns #AdvizeHealth #FutureLeaders #InternshipExperience
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🚀Monthly All-Hands Meeting! ✨ We’re excited to: - share updates, - celebrate our successes, - and align on our goals for the month. Proud of our amazing Advize Team! #HealthcareLeaders #AdvizeTeam #CompanyUpdates #GoalSetting #TeamProgress #CompanyGrowth #EmployeeSuccess #HealthcareInnovation
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📊 Did You Know? A new survey from the National Association of Insurance Commissioners (NAIC) found that only about 1 in 4 Gen Z adults can accurately define 'deductible' and 'co-pay.' Understanding healthcare terms is crucial for making informed decisions about our health and finances. 🌟 Why does this matter? Deductible: The amount you pay for covered healthcare services before your insurance plan starts to pay. Co-Pay: A fixed amount you pay for a covered healthcare service after you've paid your deductible. 🧠 Knowledge is power! By understanding these terms, you can make better choices for your health and your wallet. 💡 Let’s change the stats together! Follow us for more insights and tips on navigating the healthcare landscape. 📖 Read more: https://lnkd.in/e4Cru2i4 #Healthcare #GenZ #HealthLiteracy #AdvizeHealth #Empowerment #InsuranceTerms
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💭Imagine a partner that understands your needs before you even do. Clients often present a list of needs and goals, but at Advize, we go beyond just meeting expectations. We deliver what our clients don't yet know they need, rising above the industry norm to exceed expectations. 💭Imagine data that works for you. Instead of just pulling data for review, we leverage data analysis to identify targets and savings. Our holistic approach to patient and provider services/billings provides a complete impact risk assessment, offering a clearer picture of potential risks and opportunities. 💭Imagine reports that build trust and demonstrate true value. Trust, value, and ROI are critical, but we take it further. By calculating deterrence and incorporating it into the overall return, we showcase the total impact of our work. From stopping a billing pattern to recommending termination from a plan, deterrence represents the losses prevented by our proactive approach. 💭Imagine the difference with Advize. We don't settle for average. We think outside the box and fight against the status quo, ensuring our clients see the full value of partnering with us. With Advize, you get more than just a service; you get a strategic ally committed to your success. By Brad Smith #HealthcareTransformation #DataAnalysis #ExceedExpectations #TrustAndValue #ROI #AdvizeHealth #ProactiveHealthcare #IndustryLeadership #HealthcareInnovation
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⭐ Meet Dan Nicolino, CFE, Manager of Healthcare Fraud and Abuse at Advize. Driven by his passion for solving complex problems and making a tangible impact, Dan uses his analytical skills to combat fraud, waste, and abuse in the healthcare system. Learn more about how Dan’s work is safeguarding financial resources and ensuring quality patient care. - - - Why I Chose to Work in Healthcare? I decided to become a healthcare investigator because of my strong drive to solve complex problems and make a tangible impact on the healthcare system. It has allowed me to use my analytical skills to identify and address issues such as fraud, waste, and abuse, which can hinder the delivery of quality care. By uncovering these problems and developing solutions, I contribute to creating a more efficient and effective healthcare environment. The challenge of untangling intricate cases and the satisfaction of protecting patients and resources make this career incredibly rewarding. Why I Continue to Work in This Industry? I continue to work as a healthcare investigator because of the critical role this work plays in safeguarding financial resources and combating newly emerging fraud schemes. The healthcare industry is constantly evolving, and with it, so do the tactics of those attempting to exploit the system. By staying ahead of these schemes and developing innovative strategies to detect and prevent fraud, I help ensure that funds are used appropriately, directly benefiting patient care and reducing overall healthcare costs. #VoicesOfHealthcare #HealthcareIntegrity #FraudPrevention #AdvizeHealth #HealthcareHeroes #ProgramIntegrity
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⛅ As part of our commitment to clear and honest communication, we want to share what's currently happening with Medicare billing practices. This blog will break down the recent investigative findings and their impact on the healthcare system and your care. Our aim is to present these complexities in a way that’s easy to understand and relevant to you. At Advize, we are dedicated to ensuring transparency and integrity in healthcare, and this is one of the ways we keep you informed and engaged. #MedicareAdvantage #HealthcareEthics #BillingIntegrity #PatientCare #HealthcareTransparency #HealthcareOversight #MedicareBilling #EthicalHealthcare #HealthcareCompliance #AdvizeHealth #HealthcareReform #MedicareReform #HealthcareAccountability #HealthInsurance #CostOfCare