About Us

 Medical Datalytics LLC specializes in the recovery of unbilled and under billed physician administered drugs. Our consultants and billing analysts possess the unique skill sets necessary to provide the 

granularity and insight required to identify Medical Pharmacy revenue leakage. Having practiced in the Financial and Healthcare industry since 1983, the firm has decades of collective and comprehensive Payer and Provider knowledge and experience.  

 Medical Datalytics can help your hospital significantly improve its bottom line without any financial risk. The service is non-intrusive performed offsite to prevent any lost productivity to your overworked business office. Utilizing our proprietary algorithms we data mine your facility's electronic claim and remit data to identify billing outliers. These identified claims are then reviewed by our billing analysts against a provider's CDM/Formulary data and associated medical record information to provide documentation of all charge errors. The deliverable to the client is the necessary information to re-bill the validated claims to their respective payers and then monitored until payment is received. 

Auditing for the under-billing and under reimbursement of Physician Administered Pharmaceuticals is a niche specialty. Yes, most RCM auditors claim the scope of their expertise includes pharmacy recovery but this is usually only the result of when researching a claim for some other reason a pharmaceutical anomaly is discovered. Our only focus is on Medical Pharmacy and the billing processes that cause the  incorrect charging and/or reimbursement of a claim. CMS granted us a Data Use Agreement to analyze every US facility's submitted Medicare claim data to determine which facilities were still be challenged with the correct billing of Medical Pharmacy. If you are experiencing certain billing issues with Medicare claims those same issues are more than likely also occurring with your other non-governmental payers.