Compliance Auditing

Compliance-Audit

Have you ever had Medicare recoup claims? This is very common in the complex world of Medicare and insurance billing. How much time and profit are you losing? Our team will audit your practice for complete compliance and make recommendations to keep you in good graces with all payers. You will have peace of mind knowing you can withstand any audit while reducing recoups and cutting cost by billing clean the first time.

SCOPE OF SERVICES

Compliance Services, Billing & Coding, HIPAA, OSHA, Payer Audits & Investigations

Compliance/HIPAA Audits and Mach Audits

  • Review patient charts and claims to ensure compliance with billing and regulatory requirements
  • Review receivable reports and claims history
  • IT – HIPAA Audits

Compliance Program Development, Training and Management

  • Compliance (billing), HIPAA, HITECH, OSHA, HR
  • Review your existing program and provide recommendations and updates
  • E-learning now available 4 programs available now and 3 more to come
  • 12-month managed Compliance Programs

Payer Audit Defense including RAC & ZPIC audits, interviews, etc. in coordination with your attorney, if applicable

Accounts Receivable Analysis for Improved Collections

  • Review a sample of write-offs for accuracy and potential recovery
  • Review of claims history and aging

Chronic Care Management Tools for Medicare Required by 2018

2017 AUDIT TARGETS

  • Compliance Programs (billing, coding, relationships) & HIPAA all required!
  • OIG Work Plan 2017
  • Documentation that Employees, Contractors and Vendors are check against sanction databases (see website for links)
  • Contracts physicians have for Anti-kickback & Stark Issues
  • Level 4 & 5 office visits (All payers)
  • Incident to Services (All payers)
  • Outlier of services because physician does in-house tests, radiology, etc.
  • Services provided by SNF and in SNF by physicians
  • Physicians ordering drugs “off label” (not for FDA approved purpose)
  • Hospice services because 82% of patients don’t qualify (Terminal?)
  • Home Health (are patients homebound really)
  • Mental Health due to Parity Law (All payers)
  • Dental Services – Texas Medicaid Programs – showing a decrease
  • OCR & KPMG – Voluntary and Investigative Audits

Contact us to talk about this service.

Chronic Care Management Program ° Physician Mail Order Pharmacy ° Compliance Auditing ° Billing Solutions
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