Healthcare Business Consultant

COMPLIANCE & REGULATORY RISK

ADRs, Audits & Appeals

Healthcare providers face significant compliance and regulatory risks, including audits, appeals, and the complex process of addressing Additional Documentation Requests (ADRs). Non-compliance with regulations can result in penalties, funding loss, and reputational damage. To help providers navigate these risks, we offer comprehensive services tailored to their needs.

Our team of compliance experts provides guidance to help clients prepare for audits and appeals, including the development of a comprehensive approach to address ADRs. We collaborate with organizations to review documentation, identify potential compliance risks, provide education and training to staff, and develop effective strategies for managing audits and appeals.

AUDIT & APPEAL PREPARATION AND SUPPORT


  • •  External audits can be triggered by government agencies, private insurance companies, or other regulatory bodies and can be time-consuming and resource-intensive for organizations to manage.
    •  Audit and Appeal Preparation & Support services can help organizations prepare for audits, including conducting internal audits, developing policies and procedures, and ensuring compliance with industry regulations and standards.

COMPLIANCE RISK ASSESSMENT AND ANALYSIS

  • Compliance Risk Assessment and Analysis services are designed to help healthcare organizations assess and manage potential risks related to regulatory compliance. These services provide an objective evaluation of an organization’s compliance practices, identify areas of risk, and recommend strategies to mitigate them. They assist in developing and implementing effective compliance programs, including policies, procedures, training, and monitoring activities. Compliance Risk Assessment and Analysis offer valuable insights and recommendations to executive management and board members, ensuring compliance with regulations and minimizing legal and financial risks.These services can provide an objective evaluation of an organization’s compliance practices, identify potential areas of risk, and recommend strategies to mitigate those risks.
    These services can assist organizations in developing and implementing effective compliance programs, including policies, procedures, training, and monitoring and auditing activities.
    Compliance Risk Assessment and Analysis can provide valuable insights and recommendations to executive management and board members to help ensure compliance with regulations and minimize legal and financial risks.

STAFF EDUCATION & TRAINING ON COMPLIANCE

  • Staff Education & Training on Compliance services offer comprehensive training and education programs for healthcare organization staff. These programs ensure that staff members understand and comply with relevant laws, regulations, and policies. The training helps them develop the necessary skills and knowledge to meet compliance requirements and perform their job functions effectively. Topics covered may include HIPAA, fraud and abuse laws, coding and billing requirements, and privacy and security regulations.

ADR SUPPORT AND RESOLUTION

  • ADR Support and Resolution services assist healthcare providers in navigating the ADR process and resolving claims disputes with Medicare and other payers. These services help providers understand the ADR process, gather required documentation and evidence, and submit compelling cases to the reviewer. They also offer assistance with denials and appeals, including reviewing documentation, identifying potential issues, and suggesting opportunities for improvement.

PLAN OF CORRECTION DEVELOPMENT AND IMPLEMENTATION

  • Plan of Correction (POC) Development and Implementation services aid healthcare providers in addressing deficiencies identified during regulatory surveys or audits. These services help providers develop comprehensive POCs that outline the steps they will take to correct identified deficiencies and prevent their recurrence. POC Development and Implementation services also assist providers in implementing the corrective actions outlined in the POC and ensure effective resolution of identified deficiencies. These services help providers achieve compliance, avoid penalties, and maintain their accreditation and certification status.

Our expertise is particularly valuable when dealing with ADRs. Providers often encounter vague or insufficient ADRs, causing frustration and delays in the claims process. Our compliance team has experience in addressing ADRs and working with payers to quickly resolve issues, ensuring timely reimbursement for providers. In the event of an audit or appeal, we provide support throughout the entire process. Our experts review documentation and provide guidance on responding effectively to audit findings and appeals. We also assist in developing an effective Plan of Correction to address any identified deficiencies during the audit. We understand the importance of compliance and regulatory risk management for healthcare providers, and our dedicated team of compliance experts is committed to helping clients achieve ongoing compliance and minimize risks. Contact us today to learn how we can assist your organization in navigating the complex world of compliance and regulatory risk.