Recoverable variance
Underpayments, locality mismatches, and rate differences that deserve follow-up.
D3rx
Main product
Medicare Audit
Audit paid original Medicare fee-for-service professional claim lines against CMS-backed rates and payment-policy indicators. D3rx separates recoverable variance from compliance risk so your team knows what to rebill, review, or document.
Sample finding
POS rate variance
Paid allowed$95.00
CMS benchmark$135.61
NCCI
MUE
PFS
What the audit checks
PFS, CLFS, and ASP rate variance
NCCI procedure-to-procedure edits
MUE unit limits
MPPR, bilateral, and global-surgery payment indicators
PC/TC modifier validity
Place-of-service rate mismatch
Telehealth eligibility
Assistant, co-surgeon, and team-surgeon indicators
Findings are routed into action queues
Compliance risk
Overpayments, NCCI/MUE issues, invalid modifier use, and other items to review before they become audit exposure.
Documentation review
Findings that need chart support, modifier rationale, or policy confirmation before action.
Data gaps
Missing ZIP, modifier, date, or code data that prevents a clean determination.
Scope: original Medicare fee-for-service professional claim lines. Institutional, DMEPOS, OPPS facility, Medicare Advantage plan-specific variance, Medicaid, and commercial payer variance are outside this audit.