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Risk & Compliance

Fraud & Forensics|Revenue Cycle

Documentation, Coding and Billing Reviews

We have a team of certified coding experts who perform outpatient and inpatient documentation and coding reviews to evaluate the quality of medical record documentation to support accurate and specific procedure and diagnosis coding as well as the accuracy of the assigned codes.  You will be provided with a detailed report identifying any potential risk areas as well as documentation and charge capture opportunities.  These reviews can be performed on an as needed basis or as part of the regular compliance program auditing process.  We also provide shadow auditing services as part of your ongoing education and training efforts. 

Independent Review Organization (IRO) Services

We currently serve as the Independent Review Organization (IRO) for both physician group practices as well as large hospital systems.  Our IRO services include unallowable cost reviews, statistical sampling and extrapolations, documentation, coding and claims reviews, as well as medical necessity reviews for providers with Corporate Integrity Agreements imposed by the Office of Inspector General.

Medical Necessity Reviews

We have a contracted team of board certified physicians with expertise in a variety of clinical areas including:  emergency medicine, wound care, internal medicine, cardiology, interventional cardiology, electrophysiology, family practice and pediatrics.  Our physicians review medical record documentation to determine medical necessity for inpatient admissions and procedures as well as outpatient services.  Our physicians have vast experience in peer review, investigations, testimony, and Corporate Integrity Agreements.

Customized Education and Training

We offer customized education and training to coding, billing, clinical and administrative staff based on the unique needs identified internally or the specific findings discovered through one of our review services.  Every educational session is designed to be interactive and incorporates meaningful case examples.  We have the capabilities to provide these sessions through teleconference, web conference, or in person based on your needs.

Billing Performance Reviews

Our team of experts will perform a review of the entire billing process to confirm accuracy and efficiency at all crucial points.  Using detailed analysis of key billing reports, employee interviews and sample account detail reviews, we compare the organization’s performance to national recognized industry standards and objectively identify areas of risk and opportunity.

Denial Management Reviews

We offer monthly, quarterly or annual denial management reviews.  These reviews are designed to identify trends and opportunities for operational performance improvements.  We will provide detailed reports outlining the findings, risks and recommendations for process improvement to reduce denials, lost revenues and compliance risk and improve financial performance.

Policy and Procedure Review and Development

Our team of experts is available to work with you to revise or develop and revise policies and procedures based on the individualized needs and risks of your organization.  We work in collaboration with your staff to prepare necessary policies and procedures to reduce compliance risk and optimize operational performance.

Support Services

We offer monthly service and support packages to provide our clients with authoritative guidance to their documentation, coding, coverage and billing questions.  We provide written responses with corresponding citations with 2 business days to allow timely resolution of any questions or concerns our clients may have and prevent unnecessary delays to the revenue cycle process.

Acquisition Agreed Upon Procedures/Risk Assessments

Our team will work in collaboration with you to perform  reviews of known or potential risk.  We will identify critical areas that may pose compliance or operational risk and provide a detailed analysis and recommendations based on the review findings.  In addition, we are able to assist you in the investigation of any potential risks identified during the course of our review as well as provide expertise regarding risk mitigation strategies.

Financial Consulting and Cost Reporting

  • Cost Report Preparation and Consulting

We currently prepare cost reports for clients throughout the country. Our system for gathering information and preparing cost reports is designed to minimize client time while improving accuracy and compliance. We are regularly called upon as cost reporting subject matter experts and have testified in federal court.

In addition to cost reporting, we regularly assist our home health and hospice clients in designing and updating operational budgets as a benchmark for guiding the business. We also provide ongoing accounting support services ranging from assistance with specific accounts to revenue recognition accounting, as well as assisting in the design and maintenance of a chart of accounts customized to your operational needs.

  • Financial Analytics

Productivity improvement, cost control, or revenue optimization all begin with meaningful financial analytics. Our team has hands-on operating experience, including agency ownership, and can bring that expertise and perspective to your organization.