Regulatory Compliance

We Deliver on the Promise of keeping you up-to-date and in compliance with all of the latest regulations governing healthcare business practices today.

The healthcare industry is perhaps the most highly regulated of all industries. The government and private payers are continually searching for ways to reduce healthcare expenditures. Concerns regarding privacy and security, Stark and anti-kickback, along with the Office of the Inspector General’s documented targets for fraud and abuse, leave many providers and their staffs unknowingly vulnerable. Privacy and security breaches can result in corrective action by the government as well.

While many organizations already have internal compliance processes in place, periodically, an external party review of these processes can bring impartiality, knowledge of the industry, and outside experiences that may not always be available within your organization.

If your resources are limited, we will work with you to establish and prioritize your risks and, in turn, develop a budgeted plan for the provision of compliance services.

Although there are many areas to be considered when discussing compliance, some of the services we can provide include:

Medical record documentation and coding reviews
Risk assessments (Coding, billing and HIPAA compliance)
Compliance plan development, execution and review
Outsourced compliance officer
Compliance audits –Performed for you and/or your outside billing company.
Physician and employee education
Contract assistance – to evaluate or restructure relationships with outside entities
Litigation advisory services –In the event of large repayment demands from payers, or when faced with the possibility of fraud and abuse allegations for non-compliance, we provide expertise in preparing a strategy for your defense. Through extensive research and auditing of claims, we determine the validity of the demand or allegation.