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AdvanceMed, an NCI Company

Meeting the Mission Needs of our Health IT Customers

Uncovering fraud, waste and abuse requires refined methodologies and “big data” best practices applied to program-integrity vulnerability assessments, case management, investigative services, data management and analytics, medical record review and medical record management. AdvanceMed, an NCI Company, provides all of this while playing a key role in improving the integrity of the U.S. healthcare system.

Our specialized skill sets span information technology (IT) services, electronic health records management, data analysis, case management, medical review and investigations. We provide fraud investigation, proactive data analysis, and secure IT infrastructure services.

Our solutions use advanced analytic tools against diverse and high-volume data sets to support “big data” processing in our secure data center. Because our solutions capture comprehensive long-term billing history, leverage near-instant access to medical data when and where it is needed, and automatically identify potential medical practice miscoding, our medical professionals are able to efficiently and effectively uncover fraudulent activities.

For maximum effectiveness, we complement advanced analytic needs with benefit-integrity analysts, fraud investigators, legal counsel, data analysts and medical review specialists. Through these efforts, AdvanceMed brings all the necessary elements to enable clients to successfully meet their objectives and mission needs:

  • Data Quality and Management
  • Advanced Statistical and Time-Series Analysis
  • Case Management
  • Fraud Investigation
  • Medical Coding Review
  • Medical Record Management
  • Secure Virtual Desktop Infrastructure Data Center Optimization

About AdvanceMed, an NCI Company

AdvanceMed helps U.S. federal agencies reduce improper payments by fighting fraud, waste and abuse in entitlement programs. AdvanceMed utilizes analytic techniques and automated tools to aggressively identify fraudsters who have already made it into the system and to stop fraudulent activity before it gets to the entitlement system. Our workforce delivers outcomes that reduce overpayments, improve understanding of policy and payment vulnerabilities, contain costs, eliminate backlogs, and improve documentation for case referrals and overpayment recoveries. Our services combine extensive practical medical coding knowledge with strategic analytical skills and law enforcement experience to ensure every task is conducted at the highest levels of efficiency and discretion. We are a Medicare Program Safeguard Contractor, a Zone Program Integrity Contractor, and a Review of Provider Medicaid Integrity Contractor. AdvanceMed aligns with cutting-edge resources, analytics and capabilities, allowing for progressive healthcare integrity in today’s fluid environment.

AdvanceMed’s staff of nearly 500 employees consists of medical professionals, data analysts, medical record managers, fraud investigators, statisticians, IT support specialists and program management professionals. Our medical professional staff consists of board-certified physicians, nurses, physical therapists, occupational therapists, speech language therapists and other allied health professionals. Our past performance includes a broad spectrum of experience, and we have developed a comprehensive approach to fraud detection and prevention that utilizes our extensive resources.

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