Coding and compliance have been under the magnifying glass since the passage of the Health Care Portability and Accountability and Federal False Claims Acts in the early 1990's. With increasing scrutiny of providers' documentation and coding, it is important to have functional compliance plans and ongoing monitoring through auditing and education.
The creation of compliance program guidances is a major OIG initiative in its effort to engage the private health care community in preventing the submission of erroneous claims and in combating fraudulent conduct.
Our organization is recognized as an Independent Review Organization by the Office of Inspector General and complete initial assessments, implementation and annual reports with statistical analysis as outlined in the Integrity Agreement.
Contact us today if you need an IRO engagement or completion of an OIG annual report.
Voluntary Programs & Training
Compliance Programs. Fraud & Abuse programs tailored to your specific healthcare service(s).
HIPAA. Development of new and/or review of existing program and manuals combined with annual training.
OSHA. Assessment to determine and lessen areas of risk, development and/or review of manuals combined with annual training.
Identifying and correcting potential vulnerabilities in your practice optimizes claims payment, minimizes billing mistakes, reduces the chance of an audit, averts protected health information (PHI) breaches, and avoids conflicts with Stark and other anti-kickback statutes.
Reviews of medical documentation are customized to identify and lessen audit risks and overpayments through correct coding, provider and staff education and documentation training.
Contact us today for for more information about our compliance audit services.
Private Equity Acquisitions
It is no secret that the buying of medical practices or business interests is a growing business. We assist equity firms and thier legal team in understanding the financial risk of assuming these business by examining how the revenue was generated - the documentation, coding and billing of medical services or supplies. We assess audit and regulatory compliance risk should a postpayment audit take place. Buyer Beware - A Medicare, Medicaid, or Third-Party Payer audit and financial demand goes to the current owner of the business.
"Know your risks before you buy" applies to the buyer of medical services. We specialize on assessing risk for DME and Ambulance as well as most physician specialties and ambulatory surgery centers.