We review 10 of your claims against the four documentation pillars audit contractors actually examine, and deliver your measured extrapolation exposure — in dollars, not generalities.
Most providers prepare for the audit's direct findings. The extrapolation calculation is where the operations actually break.
The error rate you carry today is the single biggest determinant of what a future demand letter will say. Most operations have never measured theirs.
Every claim in your review is scored on each of these four areas, with traffic-light risk ratings and specific remediation guidance.
Proof of delivery signed and dated. Tracking documentation retained. Delivery ticket matching the date of service billed on the claim.
ICD-10 specificity supporting medical necessity for the HCPCS billed. Primary and secondary diagnoses aligned with the equipment.
Physician follow-up notes within required windows. Compliance reports captured. Recertification documentation where applicable.
Detailed Written Order dated correctly. Face-to-face encounter notes in window. Prior authorization documented where required.
One document. Six components. Built around the same evaluation framework UPIC and RAC contractors apply.
Engagements are led by Ted Jones, CEO of BFLOW® Solutions. Outside of BFLOW®, Ted currently conducts audit reviews for a major national multiemployer benefit fund — meaning he sits on the payer side of these reviews several times a week, looking at exactly the kind of provider documentation that UPIC and RAC contractors examine on the Medicare side.
The methodology is the same. The failure patterns are the same. The dollars at stake are the same. You are not being reviewed by someone who learned this from a textbook.
Submit the consultation form. A senior consultant follows up within one business day.
Sign a simple engagement letter. Receive secure document upload link.
Provide 10 claim files with full supporting documentation through encrypted upload.
Each claim scored against all four pillars. Extrapolation exposure modeled.
30-minute executive walk-through with Ted. Written report delivered.
flat fee · five business-day turnaround
No. This is a documentation defensibility review designed to surface gaps so you can remediate them before a real audit. It does not constitute legal advice and does not guarantee any specific audit outcome.
For each of the 10 claims: the claim file, supporting documentation (DWO, face-to-face notes, POD, prior auth where applicable), and any continuous use records. We provide a checklist at engagement so nothing gets missed.
All documents are transmitted through encrypted upload and handled under BAA-protected workflows. PHI is never stored outside secured systems. The engagement letter includes specific data handling terms.
Yes. The flat-fee engagement covers 10 claims from a single location and single category. Multi-location and multi-category engagements are quoted on request — a 20-minute scoping call sizes the appropriate review.
The right time to measure your error rate is before someone else measures it for you. Providers who get hit hardest in audits are not the ones running sloppy operations — they are the ones who believed their documentation was fine until it was actually checked.
No. The review evaluates documentation, not technology. Your findings stand on their own regardless of what billing system you use. The remediation roadmap sorts gaps into workflow-level issues and process-level issues — what you do with that information is up to you.
Five business days. Four pillars. One number that tells you what's at risk.
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