Reactive · Priced per claim
They pulled your records. Every one is a payment decision.
ADR, TPE, SMRC. When a Medicare contractor requests records, every claim in that packet is revenue you have already earned and not yet kept. We review the exact records they pulled, against the standard they will apply, and make them defensible before they go back.
days from your go-ahead to a finished response packet back in your hands, with time still left on your response clock.
documents in a typical claim. Every one is read against the standard a reviewer will apply, not sampled, not spot-checked.
per claim, flat. Count the claims on your letter and you have your number before you speak to anyone.
Send the letter. Get a number. Then decide.
Most agencies lose the first week deciding what to do. Your response clock does not pause while you shop for help, so we made the first step cost nothing.
Send us the letter
Forward the contractor request exactly as it arrived. We count the unique claims in the packet. That count is the only thing the price depends on. It is a number you can read off the letter yourself, before you ever speak to us.
Your number, without the wait
Flat $750 per claim, so the price is arithmetic rather than a negotiation. No hourly meter, no discovery call required to get a figure, and no “that was out of scope” invoice at the end. Sixty percent starts the work.
Every document, against the standard
We work the records the contractor actually pulled through the D.O.C.U.M.E.N.T framework, checking eligibility, terminality, and the narrative that has to carry the claim, then separating what will survive review from what will not.
A packet you can defend
Findings claim by claim, the documentation that supports each one, and an honest account of the gaps that nothing can support. Seven days from your go-ahead it is back with you, and you send a response you can stand behind with a written record of why it holds.
What lands in your inbox.
The deliverable is a decision-ready record, one your DON can act on and your CFO can take to the bank.
A claim-by-claim defensibility finding
Every claim in the request, scored against the criteria a reviewer applies. You see which claims are solid, which are exposed, and exactly which document creates the exposure.
The supporting record, assembled
The documentation that carries each claim, organized the way a reviewer reads it, so your response argues its own case instead of asking someone to go hunting for it.
The gaps, named honestly
Where the record will not hold, we say so and tell you why. Knowing which claims are indefensible before you respond is worth more than a number that flatters you.
The pattern behind the pull
Contractors do not select at random. We tell you what the sample suggests about your documentation habits, which is what determines whether this happens again next quarter.
Turnaround inside your window
Scoped to land before your response deadline, not after it. The date is in the quote, and the date is the commitment.
A direct line, not a ticket queue
Questions get answered by the senior clinician who actually read your charts, not by an associate working from a summary of them.
Placeholder, client quote pending.
From $750 per claim.
A typical claim runs 35 to 45 documents, and every one of them is read. The price is per claim, not per document, so it holds whether your claim runs light or heavy. One claim is the floor. Beyond that the price follows the claim count in your letter, a number you already have, which is exactly why we price on it instead of on our hours.
Sixty percent begins the work and the balance falls due when your packet is delivered. That delivery lands within seven days of your go-ahead, which leaves room on your response clock instead of eating it.
What administrators ask when the letter lands.
When is payment due?
Sixty percent on go-ahead, the balance when your packet is delivered. The total is knowable before you commit to anything: it is $750 per claim, and the claim count is printed on the letter in your hand.
What exactly is an ADR, and why did we get one?
An Additional Documentation Request is a Medicare contractor asking you to prove a claim you have already been paid for. It is not an accusation and it is not a survey, it is a payment review. Recent CMS changes have made document review, not the survey, the regulatory event agencies face most often. Getting one does not mean you did something wrong. Responding poorly is what turns it into recoupment.
We are under TPE or SMRC, not a single ADR. Same thing?
Same model. Targeted Probe and Educate and Supplemental Medical Review Contractor requests pull more claims, so they cost more, but the unit does not change: we price per claim, quote it fixed, and review every document in the pull.
Can you guarantee we get paid?
No, and be careful with anyone who does. We can guarantee that what you send back is the strongest defensible version of the record you actually have. Where the documentation cannot carry the claim, we tell you before you send it rather than after the denial.
Why per claim instead of per hour?
Because you can count claims and you cannot count our hours. The claim count is printed in the letter in your hand. Pricing on a unit you control is the difference between a quote and a blank check.
This keeps happening. Is there something upstream?
Usually, yes. A repeat pull is a documentation pattern, not bad luck. Defensibility work fixes the packet in front of you; External QA fixes the habit that produced it, org-wide and ongoing, so the next request is a formality instead of an emergency.
Who this is for, and who it is not.
Right fit
An agency under active review that wants the record to hold, is willing to hear which claims will not survive, and intends to fix what the pull revealed. Founder-owners who sign the check and carry the clinical risk in the same afternoon.
Wrong fit
Anyone shopping for a rubber stamp, anyone who wants findings softened, and anyone buying on lowest price alone. If a corrective action is going to be ignored, the review is an expense rather than an investment, and we will say so before you spend the money.
Referral partners
Healthcare attorneys, billing companies, EMR and software vendors, and accreditation consultants send us work when a client lands under review. If your client got the letter and you need the clinical documentation reviewed properly, start here.
The rest of the ladder.
Defensibility is the reactive door, it answers the request in front of you. If nobody is at your door yet, start upstream.
External QA
Independent oversight of your documentation across the whole organization, every month. The proactive version of this page: find what a contractor would find, before a contractor is looking.
From $3,500/mo →
ProgramSurvey Readiness Program
The full eight-week build when the survey, not the document request, is the event you are preparing for.
From $20,000 →
Send the letter. Get a defensible packet in seven days.
Forward the request exactly as you received it. We will count the claims, confirm the figure at $750 apiece, and tell you honestly whether this is worth doing before you commit to anything.