FHAS maintains a panel of more than 140 review physicians encompassing the specialties and sub-specialties of the American Board of Medical Specialties (ABMS). Each physician within FHAS’s physician panel is board certified in their respective area. Our physicians have extensive experience in peer review, claims adjudications, and managed care organizations (MCO) disputes.
CERTIFIED NURSE REVIEWERS
FHAS maintains a nationwide comprehensive review team of licensed Registered Nurse Review Professionals who are trained and experienced in rendering clinical decisions across all health care settings for the appropriateness of the quality of care provided, utilization review for appropriateness of determining eligibility for reimbursement, level of care and length of stay, and coding and DRG assignment/reimbursement.
FHAS’s Nurse Reviewers have vast experience adjudicating disputes regarding hospital and outpatient services, prescription medication, DME, and Recovery Auditor Contractor (RAC) appeals. Our nurse reviewers possess the CPC (Certified Professional Coder) certification through the American Academy of Professional Coders (AAPC).
PSYCHOLOGISTS / LICENSED CLINICAL SOCIAL WORKERS
FHAS has licensed clinical/counseling psychologists to evaluate and recommend treatment for healthcare services being reviewed to handle external grievances.
FHAS’ medical review network includes licensed pharmacists experienced in rendering determination regarding the medical necessity and reasonableness of prescribed formularies for Part A, Part B, and Part B Durable Medical Equipment (DME) claims.
OCCUPATIONAL THERAPISTS (OT) / PHYSICAL THERAPISTS (PT)
FHAS maintains a comprehensive professional review team of licensed physical and occupational therapists experienced in rendering clinical decisions regarding the medical necessity, reasonableness/appropriateness, and quantity of therapy services for Part A and Part B of A therapy cases.
Certified Professional Coders (CPC)
The FHAS coding team includes industry leaders who maintain the highest level of integrity when assigning and/or validating ICD-9-CM/PCS, ICD-10-CM/ PCS, CPT-4, and HCPCS Level II codes from medical record documentation for inpatient and outpatient episodes of care. FHAS’ coding professionals maintain a wide range of coding certifications, including the Certified Professional Coder (CPC), Certified Outpatient Coder (COC), and Certified Professional Medical Auditing (CPMA) certifications from the American Academy of Professional Coders, as well as the Certified Coding Specialist (CCS) certification from American Health Information Management Association (AHIMA). Our coders stand at the forefront of best coding practices and are proven leaders within the coding community.
Our legal team prides itself on providing a full-range of legal services in a prompt and cost-effective manner. FHAS is known for its preparation, thoroughness, and timely response to its clients and possesses extensive experience in the areas of healthcare and administrative law.
FHAS’s team routinely provides legal support services to private firms as well as state and federal agencies in areas including, but not limited to legal research, writing, third party negotiations, and litigation preparation.
Our attorneys possess Veterans Affairs (VA) accreditation – demonstrating a thorough understanding of VA law with the ability to provide neutral third party support to the VA and its beneficiaries.