Compliance, Accreditation & Regulatory Support
Building a strong compliance foundation in today's regulatory environment
Gone are the days where a hotline and designated compliance officer will pass for a compliance program. Rather, in today's regulatory climate, an effective compliance program should be the underlying foundation of which an organization creates a culture supporting stronger governance, better organizational communication, safeguarded revenues, higher employee morale, a culture of increased transparency and stronger alignment with accrediting body and regulatory agency requirements. Our team helps organizations build and maintain a compliance program aligned with the Office of Inspector General's (OIG) recommendations, payor requirements, federal and state regulations, as well as industry best practices.
We offer extensive compliance consulting expertise provided by professionals with deep specialization and experience in:
- Establishing new compliance programs
- Assessing and optimizing existing compliance programs
- Compliance with Corporate Integrity Agreement stipulations
- Serving as Independent Review Organization ("IRO") for claim reviews, system reviews, focused arrangements and unallowable costs
- Conducting mock IRO audits
- Providing training and education
- Interim compliance staffing
We also help clients comply with mandates from:
- Mock surveys and audits (joint commission, HIPAA, HEDIS, DNV, HFAP, CAP, etc.)
- Assessments of the documentation and billing for claims samples against payor guidelines, regulatory requirements and industry standards
- Coding audits assessing the accuracy and appropriateness of coding for claims samples, trending billing patterns to identify potential abusive practices and providing education to coding and clinical staff on deficiencies
- Value-base care reimbursement models (i.e. risk adjustment, bundled payments, accountable care organizations, etc.)
- Audits of pharmacies and pain clinics, including compliance with FDA, DEA and state-specific requirements
- Audits of clinical laboratories to ensure compliance with CLIA, CAP and COLA standards as well as state-specific requirements
- Healthcare reform and Sunshine Act assessments
- Clinical research and clinical trial assessments
- 340B assessments
- Patient rights, access and notification assessments, including MSP, ABN, charity care and insurance verification processes