The EMG Audit Process

The EMG Audit Process

processing-emg-claimsAutomated Review


Send your electronic claims to us for a rapid automated analysis. We have developed proprietary software to immediately identify and flag claims that do not meet standard performance criteria. This software is based on policies recommended by the American Association of Electrodiagnostic and Neuromuscular Medicine, the American Medical Association, the American Academy of Neurology, the American Academy of Physical Medicine and Rehabilitation, the Center for Medicare Services and most commercial payers.

Red Flagged Claims Manually Reviewed


We have reviewed the data from over 100,000 valid EMG claims for physicians who are both board certified in electromyography and board certified in their primary specialty. These physicians hold the highest degree of accreditation with the prestigious exemplary status designation. This data has formed the basis for the development of our proprietary “custom rules." Each electronic HCFA 1500 claim will automatically be scored for deviations from standard practice procedures with these “custom rules." These automatic claim reviews will answer critical questions about the qualifications of the doctor, appropriateness of equipment and technical issues.  This evaluation is unique to the industry.   In additional to evaluating each EMG and nerve conduction study for deviations from customary procedure, we will evaluate each claim for medical necessity with our extensive knowledge of Medicare and non-Medicare policies.  We also review the EMG performance criteria for most Major Insurance Providers.


Expert Physician Review with Medical Record


A board certified physician will evaluate 14 critical elements of each report to determine if the test was conducted according to practice parameters as published by the American Association of Neuromuscular and Electrodiagnostic Medicine.  This review is not automated and requires that the EMG report be available for analysis.  This review is not intended to "second guess" a qualified Electrodiagnostic physician.  The assessment will determine if the test was done seriously by qualified individuals that meet minimum standards.  These standards have been adopted by most insurance companies, the Center for Medicare Services and numerous other national, reputable medical organizations.

 

  • Ask one of our information specialists to arrange for a ten minute webinar to better understand the scope of our services. 
  • Learn how your company can assure that only qualified claims get paid. 
  • More importantly, learn how to avoid paying for inappropriate surgery by identifying tests that provide inaccurate information.

Contact Information

EMG Audit
Sales Coordinator
Phone:
877-406-3338
E-mail:
rb@emgclinics