StrategicHealthSolutions, LLC (Strategic) understands that protecting and preserving our health care dollars requires a multifaceted approach. Strategic provides private and government health care entities a range of services that support education, oversight, and enforcement of the health care programs. Use the links below to read more about our comprehensive services.
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, and 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 ensure our ability to conduct a thorough analysis of medical record documentation. This expertise also is used to validate that medical services are rendered consistent with Medicare and/or Medicaid coverage guidelines and are medically reasonable and necessary.
Strategic develops, designs, and delivers educational materials, including brochures, pamphlets, fact sheets, PowerPoint® presentations, web-based training, and reference guides to a wide range of audiences such as beneficiaries and providers. Experienced editors, curriculum writers, Subject Matter Experts (SMEs), trainers, graphic artists, and Web developers work collaboratively to create topic-specific educational tools using a variety of plain language materials available in print, Web, and mobile formats.
Strategic provides compliance and regulatory monitoring audits. Areas of focus include medical management oversight, detection of aberrancies through data analysis, overpayment identification, and detection of program vulnerabilities. Audit tools are tailored to each audit type and include methods to determine compliance with organizational policies and procedures and regulatory requirements.
