Health Care Compliance Advisors, LLC
Health Care Compliance Advisors, LLC was founded by Dan Johnson in 2010. We provide over 50 years of auditing, compliance, and management experience for our clients.
New Compliance Outsourcing Program
The demand for compliance audits, policies, programs and talent has increased the cost of maintaining compliance infrastructure for most organizations. Even with proper funding, the ability to grow compliance operations may be limited by the availability of adequately qualified people to an in-house compliance function.
We are introducing a new program that outsources compliance requirements such as auditing and monitoring, training and other essential elements of a successful program. Our aim is to supplement the compliance efforts of an in-house operation, which could require an ever-increasing investment in talent and IT resources.
Focus on the Numbers
In today's health care climate, scrutiny of insurance claims is even greater. In fiscal year 2013, CMS estimated that improper payments, some of which may be fraudulent, were almost $50 billion.
The key to success includes "doing it right the first time" but also active monitoring the shifting regulatory and medical billing environment and ensuring that "claims are submitted as correctly as possible." While there is the underlying margin of error,after all we are only human. Mistakes can be costly and may lead to fraud allegations. Click Here for recent CMS Audit Findings.
The consequences can be life and career changing. Contact us for a for a free E&M CPT code utilization profile, the same type of profile used by payors to identify audit targets.
Attorney Support Services
The regulatory environment is complex and involves many disciplines including legal and health care consulting. Approximately half of our projects involve health care providers retained by legal counsel. We are engaged direclty by the attorney to provide an outside opinion regarding the coding, billing, and documentation of medical services. Compliance programs and audit defense are recommended to be performed under attorney-client privilege to help protect the health care entity from adverse actions that can arise through a discovery or investigation.
We continue to partner with many leading regulatory health care attorneys. If you believe you need a health care attorney we will be happy to give you recommendations upon request.
Hospital Support Services
Hospitals have dramatically increased the number of physicians they have employed. However, they have not significantly increased the number of employees to manage and monitor physician practices effectively.
We provide physician compliance support services to hospitals that include: auditing and education, coding and compliance presentations, investigations, due diligence and audit defense. We also provide onsite practice management services including revenue cycle management and collections, human resource management, managed care contracting and negotiations, fee schedules, policies and procedures and compliance programs.
The majority of these projects are performed at the direction of hospital or outside legal counsel and Compliance Department and include but are not limited to:
- Annual Compliance Audits and Reports
- Idenitification of Overpayments: Corrective Action and Refunds
- Third-Party Payer Audits and Overpayment: Defense and Appeals Including ALJ Hearings and Testimony
- Individual or Group Provider Training and Education
- Hospital Services that bill Part B: Compliance Review of Ancillary Departments that bill for thier services to Medicare and third-party payers (e.g., Physical Therapy)
- Integrity Agreements and Reporting Requirements
Contact us today for a free hospital support services consultation.
- Coding and Documentation Audits
- Audit Defense
- Coverage Research & Coding
- Compliance Audits & Programs
- Physician & Staff Education
- Compliance Programs & Outsourcing
- Corporate & Individual Integrity Agreements
- Private Equity Acquision
- Due Diligence Audits & Investigation
- Independent Review Organization (IRO)
- Physician Practice Operational Assessments
- Physician Practice Management
- Practice Valuations
- Speakers & Presentations
- Revenue Cycle Assesments
- Strategic Planning
- Organizational Governance & Structure
Most projects are estimated on an hourly basis. Flat Rate pricing is available upon request as are free estimates. We are happy to come to your place of business. Travel related expenses are billed in addition to consulting services.