Services

 

Unique Experience & Skill Sets

The services provided by the Private Compliance Group are enhanced by unique experience and skill sets not normally found in healthcare compliance:

•we are adept at daily operations and communications that are under attorney work product privilege. This is routine for us as we successfully navigate through regulatory defense.

•expertise in defense team support for all levels of audits, investigations, appeals, and testimony.

•detection and review of off-shore coding and billing has been invaluable in support of due diligence in mergers and acquisitions or other engagements.

Regulatory Defense Support 

Civil Investigative Demands

A Civil Investigative Demand is extraordinarily broad and intrusive and is being used with increasing frequency. We are adept at providing defense team support in answering or appealing all levels of a CID as they evolve during an investigation, including testimony as might be required.

Contractor Recovery Audits

Overshadowed of late by the CID, the recovery audit nonetheless remains the primary actionable audit model. Strong knowledge of the audit process, and particularly the documentation trail, enables us to provide defense team support at all levels of response to a recovery audit.

Due Diligence Support

Mergers & Acquistions

Extensive experience in health care mergers and acquisitions gives us the ability to produce quality findings consistently. We use on-site visits and personal interaction as needed, along with extensive reviews of data and documentation to provide a depth of results which are meaningful to the venture.

Corporate Integrity Agreements

Complying with each provision of a Corporate Integrity Agreement is a key factor in successfully maintaining operations while meeting the obligations of a CIA.Timely reporting is vital in a CIA, and we provide timely and meaningful information which is supportable and is strengthened by necessary education for long- term compliance.

Proactive Compliance

Pre & Post Billing Coding Reviews

A core part of what we provide in our service structure, this area of expertise assesses the patient documentation in support of accurate procedural billing. We are timely in providing reports to our clients to better sup­port the physicians and staff with feedback in their compliance efforts while also maintaining cash flow from the billings.

Peer-to-Peer Physician Education & Presentations

As part of coding and compli­ance, we offer the unique ability to pro­vide peer-to-peer education that is understandable and applicable.This service is invaluable in achiev­ing a real and lasting change in physician compliance because peer-to-peer education offers a stronger probability of physician compliance.

Compliance Manuals & Staff Support

We create compliance manuals that are designed to be utilized, because manuals that sit on the shelf are of little use to the staff, the physician, or the facility. Work in this area is designed to enhance and support a site using the skill sets and infrastructure that are in place. In this way, the staff can focus on the content of compliance, not the delivery.

Leading Edge & Networked Technology

Leading Edge would include areas not readily covered by an LCD or an NCD. Networked technology would include smart devices in use with in-patient and out-patient care. Technical expertise combined with years of experience allow for compliance strategies in these fast- changing areas of concern. Many codes are somewhat ill-defined and subject to interpretation. 

Evaluation & Management Coding Review

Accuracy of these levels of service is paramount because recovery audits of Evaluation & Manage­ment services are often the gate­ways to further regulatory intrusion. Review and support of these codes assures accurate billing. The timely use of reports and feedback yields strong compliance results, particu­larly when combined with on-site physician education.