Services Overview

What sets our services apart from others is that we recognize that every one of our clients has unique needs. With tailored innovative solutions we assist healthcare organizations and providers to improve the quality of healthcare services they provide to patients; and through compliance we assist by strengthening their revenue streams.

Our services are extended and provided to:
  1. Hospital Systems
  2. Physician/Groups Practices
  3. Healthcare Organizations
  4. Hospices and Palliative Care
  5. Home Health Agencies
  6. Other Healthcare Suppliers

Service Details

Regulatory Compliance

In an increasingly regulated and dynamic healthcare environment, we provide comprehensive innovative compliance solutions. Our strong background allows us to design and implement proven solutions. Our services include:

  • Compliance Program Development, Review and Implementation guided by the 7 Elements ( outlined in the Federal Sentencing Guidelines.
  • Office of Inspector General (OIG) ( Work Plan review and application to Compliance Program effectiveness.
  • Compliance Program Effectiveness Evaluation Tools.
  • Compliance Program Risk Assessment Assistance.
  • Policies and Procedures Development, Review and Implementation.
  • CMS ( Medicare and Medicaid Fraud Program Risk Assessments
  • Regulatory Guidance.
  • Research Compliance Assistance.
  • Compliance Education and Training Programs.
  • Research Federal and State Regulations
  • Federal Register
  • Medicare Parts A/B
  • Medicaid
  • Commercial Payers

Revenue Cycle Management

The healthcare revenue cycle is complex and interconnected. Optimizing processes and payer relationships can bring about exceptional net revenue. This is especially important as organizational structures, reporting requirements, and reimbursement methods are changing to accommodate the new realities of the constant changing healthcare system. Our services include:

  • Revenue Cycle Performance Analysis and Improvement Assistance.
  • Revenue Cycle Enhancement Initiatives.
  • Accounts Receivable Analysis and Improvement Assistance.
  • Operational Assessments and Action Plan Implementation.
  • Medicare Recovery Audit Contractor (RAC) Program Assessment.
  • Patient Satisfaction Improvement Strategies.

Coding, Billing and Reimbursement

Our consulting services are designed to assist our clients with critical areas of coding and billing, including:

  • Targeted Coding Reviews.
  • Billing/Collections Procedures Reviews.
  • Claims Denials/Appeals Process Reviews.
  • Accounts Receivable (A/R) Reviews.
  • Charge Capture Internal Control Assessments.
  • Medical Necessity Reviews.
  • Charge Description Master (CDM) Reviews.
  • ICD-10 Transition Assistance.

Auditing and Monitoring

Our auditing services provide the added value of efficient and cost-effective services by identifying weaknesses within the medical record documentation and coding processes. Retrospective or concurrent audits will validate the quality of data and ensure accuracy in the coding processes. Our services include:

  • Due Diligence Audits.
  • Focus Audits.
  • Emergency Department (ED) Audits.
  • Risk Minimization Audits.
  • E/M Coding Audits Utilization Patterns.
  • Medicare Parts A/B Audits.
  • Medicare Recovery Audit Contractor (RAC) Audits and Appeals Assistance.
  • Medicaid Audits.
  • Commercial Payer Audits.

Provider Education

Successful documentation improvement is achieved through education. Utilizing the recommendations from auditing and monitoring practices not only improves compliance with documentation processes but also assists in appropriate revenue capture. Our services include:

  • Medical Record Documentation Medical Necessity Compliance.
  • E/M Levels - Coding for Emergency Medicine.
  • HIPAA Training.
  • EMTALA Training.
  • OSHA Training.
  • Compliance Training.

Accreditation Surveys and State Inspections

For all of surveys and/or inspections there will be representation/liaison to work with surveyors at the time of surveys/inspections. Written and verbal follow up to surveys/inspections outcomes and post surveys/inspections maintenance to ensure compliance is also available. Our services include:

Hospice / Home Health Agencies Mangement Assistance

Because of the increased volume of Hospice and Home Health services, the complexities of relationships with other providers and the new conditions of participation in the Medicare program, compliance oversight and risk assessment are a priority for success. Our services include:

  • Operations Management Assessment.
  • Licensure and/or Certification Assistance.
  • Compliance Audits.
  • Medical Record Documentation Audits.
  • Policies and Procedures Assessment.
  • OASIS Compliance Assessment.
  • Face to Face Encounter Requirements.
  • Cost Reporting Assessment.
  • Reimbursement Assessment

Licensure Assistance

Licensure and certifications are rigorous, comprehensive programs. Our services include:

Physician/Groups Practices Management Assistance

The rapidly changing healthcare environment is again pushing physicians to streamline care delivery methods. We assist devise strategies and operational solutions to create high performing, integrated physician practices. Our services include:

  • Operations Management Assessment.
  • Licensure and/or Certification Assistance.
  • Compliance Audits.
  • Medical Record Documentation Audits.
  • Policies and Procedures Assessment.
  • Cost Reporting Assessment.
  • Reimbursement Assessment.