Independent Medical Review & Clinical Validation Services
Gemini Physician Consultants provides independent medical review services including DRG clinical validation, readmission review, short stay review, and inpatient level of care determinations. Our reviews are conducted by board-certified internal medicine physicians with extensive experience in utilization management and clinical documentation improvement.
Physician review of billed diagnoses against evidence-based criteria including MCG, InterQual, and payer-specific guidelines.
Comprehensive analysis of index admissions and readmissions to determine relatedness, preventability, and payment applicability.
Evaluation of inpatient admissions against two-midnight benchmark and medical necessity criteria.
Level of care determinations using InterQual and MCG criteria for acute inpatient, observation, and outpatient status.
Michael Martin, MD