Our Services
StrategicHealthSolutions, LLC (Strategic) understands that protecting and preserving our healthcare dollars requires a multifaceted approach. Strategic provides federal healthcare agencies with a range of services that support education, oversight, and enforcement of healthcare programs.
Medical Review
Strategic provides medical review that supports several services, including:
- Medical Management policy review
- Compliance with benefit and coverage regulations
- Billing and overpayment calculation
- Fraud case support
- Expert testimony Appeals and grievance support
- Coding validation
Decisions are based on defined criteria, which are supported by regulation and meet high standards of quality.
Our team’s knowledge, skills, and experience enable us to conduct thorough analyses of medical record documentation. We also utilize our expertise to validate that medical services are rendered consistent with Medicare and/or Medicaid coverage guidelines, and are medically reasonable and necessary.
Monitoring and
Compliance
Strategic provides compliance and regulatory monitoring audits. Areas of focus include:
- Medical management oversight
- Detection of aberrancies through data analysis
- Overpayment identification
- Detection of program vulnerabilities
Audit tools are tailored to each audit type, and include methods to determine compliance with organizational policies and procedures as well as regulatory requirements.
Learn more about us
Innovative solutions for the government’s next problem.
Enriching employee lives.
Enriching employee lives.