Appeals and ADRs

With the increasing number of payer audits and the backlog of appeals facing Second Level Administrators and Administrative Law Judges, it is more fundamental than ever that your initial response to an audit is pristine.

From the initial submission to any necessary appeals, Acevedo Consulting can assist you and/or your attorney throughout this entire process. Our goal is to mitigate the practice's risk by identifying the cause of the review and creating a strong appeal. Our diligent analysis of your medical records will seek to include the following information for use in your response to the payer:

  • Supporting documentation of all services billed;

  • Documentation to support the medical necessity of services according to payer coverage guidelines;

  • The accuracy of the codes billed; and 

  • That all technical requirements have been met.

Following our review, we will provide a report of findings which can serve as an independent expert cover letter for your submission.