Why Choose

Using a combination of audit, analytic and advisory services, we focus relentlessly on our clients’ financial performance— recovering lost revenue, helping them analyze and improve processes, and functioning as a seamless extension of their business.

Our leadership team has years of experience deeply rooted in health care revenue cycle and back-end business office management. When you choose Margin Recovery International, our multidisciplinary experts will quickly leverage our business intelligence, deep expertise and proprietary technology to exhaust all available avenues to recover lost or at-risk cash.

Our bottom line is your bottom line… Work with us and watch it grow.

Our focus on relationships and results fosters a spirit of mutual cooperation, generating long-term results for our clients in a way that can be described as pleasantly surprising.

Translation: when you work with us, you’ll feel like we’re part of your team—and that we have nothing but your best interests at heart.

Our Subject Matter Expertise

  • Admissions Operations
  • Business Office Operations
  • Utilization/Case Management
  • Clinical Appeals - Commercial
  • Clinical Appeals - Audit
  • Medical Necessity Reviews
  • Utilization Management Consulting
  • Pricer Development & QA
  • Consulting
  • Contract Language Review
  • Denials Management Process Creation
  • Hospital CDM Review
  • Hospital Department Leadership
  • IT Database Development
  • IT Direction
  • Nurse Charge Audit
  • On-Staff & Off-Site Legal Counsel
  • Payment Audit
  • Physician Billing
  • Project Management
  • Provider Relations Interaction
  • Regional and National Scale
  • Root Cause Tracking
  • Training Leadership & Development
  • Trending of Large Account Volumes

Government and Payor-Specific Rules/Regulations Expertise

  • Commercial Payers
  • Medicaid & Medicaid HMOs
  • Medicare & Medicare HMOs
  • Workers’ Compensation
  • Non-Contracted/Out-of-Network Plans
  • ERISA Plans
  • Third Party Liability Disputes
  • Trauma/Trauma Activation Guidelines
  • Blue Cross/Blue Shield
  • State & Federal Legislation
  • Capitation
  • Social Security Act
  • Code of Federal Regulations
  • CMS Manuals
  • Medical Necessity Screening Criteria: MCG; InterQual
  • NCDs/ LCDs
  • CMS Conditions of Participation: Utilization Review
  • CMS 2 Midnight Rule

Maximize your revenue—faster—with no-risk services from Margin Recovery International