Engagement & Fees
How a RADV or risk-adjustment False Claims chart review is structured and priced. We are paid the same regardless of what a review finds, never a percentage of recovery and never a contingency. Structure is set to the matter, not to a rate card.
No Contingency. No Percentage of Anything.
A financial stake in the size of a matter's findings would give us an interest in finding more exposure — which is exactly the bias that would undercut the reason counsel retains an outside read in the first place. So there isn't one. This is a differentiator we lead with, not a concession we make.
- No contingency, no percentage of recovery, no percentage of anything the review turns up — under any engagement structure.
- The fee is set before the matter starts and does not move based on how many findings come back, or how few.
- Results-contingent compensation tied to a review of government-program billing carries its own regulatory problems. A flat or per-chart fee sidesteps that question entirely, by design.
A person — not the software — reviews every code and signs the findings; your engagement letter names who that is. The fee structure below describes how that work is scoped and engaged, never what any individual finding is worth.
Request a CallTwo Fee Structures, Never One Number for Every Matter
A defined audit or litigation matter and a volume chart-review engagement are different kinds of work. We price to the matter in front of us, not to a single rate card stretched across both ends of the market.
Flat Fee Per Matter
For RADV-boutique and BigLaw-scale matters
Best for
A defined RADV audit response or a risk-adjustment litigation matter with a bounded chart set and a known scope.
How it's structured
- One fee set for the matter as a whole — not a per-chart meter running underneath it.
- Scoped once the chart set and timeline are known, before work begins.
- Sized to the matter, not to a subscription tier or a seat count.
The default structure for a defined audit or litigation matter.
Per-Chart Tier
For volume and small-firm matters
Best for
Small-firm and volume-driven matters, where a flat matter-wide fee would be far more than the whole engagement is worth.
How it's structured
- Fee tracks chart volume rather than a single matter-wide number.
- Scales with volume bands and early-close terms, so a shrinking sample doesn't leave a firm paying for charts that drop out.
- Set to track prevailing coding-review rates for the segment, not a software subscription.
Built for the segment a matter-wide flat fee doesn't fit.
Priced to the matter, quoted after a conversation.
Which structure applies — flat fee or per-chart tier — depends on matter type, chart volume, and timeline. We discuss and set it before any work begins; there is no published rate card and no self-serve checkout, because this is a per-matter service, not a subscription.
Demos run on synthetic charts only. Every sample shown before an engagement begins uses synthetic charts — no real patient data, no PHI, and no BAA required to see the pipeline work.
What Every Engagement Includes — and Where It Stops
The deliverable is a signed work product. It is never a percentage, never a debt figure, and never a share of anything recovered.
What's Included
The full matter run: every submitted diagnosis that carries risk-adjustment weight read against its note, with the note language pulled and cited where a read rests on it, and every code with no payment category listed as out of scope.
The signed review queue — the reviewer's findings, including every place the reviewer's decision differed from the software's read.
The agreement / disagreement record: a directional review record showing what was checked and where the reviewer's read differed from the software's read.
Relative risk-adjustment weight, provided strictly as a triage input — so the team sees what to look at first. Not a dollar ranking, not a score of any kind on the record.
Our coding lead holds no coding certification today, so nothing on this page or in the deliverable is priced or described around a certified signature. She is also a co-founder and holds equity in this business. Any grade she gives our own engine therefore stays an internal number, and we would not offer it as proof. On a first engagement the firm's own Kovel-retained coder countersigns the work product.
What's Excluded
Statistical sampling and extrapolation. That opinion belongs to a statistician, whose declaration we are not positioned to sign. If a matter needs one, we say so up front and stay in our lane.
Adjudication, or any dollar total. We do not compute a debt figure, a damages figure, or an estimate of one — there is no dollar column on the deliverable. A finding is evidence for counsel's judgment, not a verdict.
Testifying-expert work. Engagements are retained in a consulting-expert lane; testimony is out of scope by design.