Health System and Physician Integration
- Practice Analysis and Improvement
- Physician Health System Affiliation and Employment Strategies
- Physician Compensation Model Design
- Fair-Market Value Assessment for Compensation and Financial Interests
- Strategic Planning and Implementation
- Management of Physician Divisions and Related Entities for Health Systems
- Governance and Leadership Counseling and Training for Board Members
- Development of Compliance Programs
- Personnel Training and Orientation to Maintain Program Integrity
- Management and Administration of Compliance Programs for Provider Organizations, including Pharmacy Manufacturers, Distributors, Benefit Administrators, and Retail Providers
- Design of Policies and Plans to Monitor and Control Compliance with Stark, AKS, IRS, HIPAA, EHR and ACA Requirements
Medicaid and Medicare Financial Consulting
- Development of Special Medicaid and Medicare Programs for State and Local Government Providers
- Upper Payment Limit and Intergovernmental Transfer Program Design
- Public Ambulance Program Consulting
- Long Term Care Program Consulting
- Formation and Management of Provider Contracting Organizations, including ACOs and ACO look-alikes
- Pre-Contract Due Diligence Assistance
- Assessing Systems Compatibility Between Contracting Healthcare Providers
- Structuring Healthcare Mergers and Joint Venture Arrangements
- Behavioral Health Provider Readiness Assessment
- Management Systems Assessment
- Fiscal Reporting Controls
- Clinical Manager/Staff Dashboard Design
- Review and/or Develop Systems to Assure Access, Quality Outcome, Health Integration, and Cost Containment
- Revenue Enhancement Strategies
- Strategic Planning
- Program Data Benchmarking
- Internal Client Record Review Systems
- Educational Presentations regarding New Requirements of Changing Healthcare Market
Chart Reviews
- Under- or over-coding based on documentation of three key components
- Medical necessity documented in the chief complaint
- ICD-10-CM coding to the greatest level of specificity
- Coding based on time, when appropriately documented
- Use of correct modifiers
- Correct units for all drugs, vaccines and administration codes
- Documentation by exception, copy/paste functionality, clones records
- Written orders for all diagnostic testing
- Use of ABNs when appropriate
- Incident-to billing requirements met
- Timeliness of signatures
- Use of scribes
- Required documentation for operative reports and correct surgical coding
- NCCI bundling edits
- Review of EOBs, adjustments, payment posting, and appropriate billing to patients
- Financial Benchmarking
- Payer Credentialing
- Review Practice Compliance Plan
- Front Office / Scheduling / Intake
- Billing Office functions
- Fee Schedule Analysis, upon request
- EHR / Documentation and Coding Processes
- Policies and Procedures
- Employee billing and coding education
- HIPAA training and compliance guidelines
- Financial, internet and IT security issues
- Other items as requested of deemed appropriate