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Risk Assessment Reimbursement Perform a 1-3 day prospective or retrospective review of a sample of claims to evaluate coding and documentation and identify major compliance risk areas. Includes a review of annual billing pattern(s) by provider/institution/department/type, review of charge capture document, documentation templates if utilized, a chart review of 1-10 records per provider/type of service or a set sample number for a department or institution, a review of a sample of reduced, suspended and denied claims to identify problem areas and their resolution and an operational review, including brief interviews with key personnel, to evaluate operational factors contributing to risk level. Finally, a credentialing audit of providers is integral to each risk assessment engagement. A formal report is provided. A "shadow" review service for Third Party Payer "Medical Claim Reviews" (pre-payment, post-payment, 100% review) to determine risk prior to Payer notification, is available as an add-on or stand alone engagement. In practices utilizing electronic medical records and/or electronic signatures, compliance review in these areas can be an add-on or stand alone engagement A review of any applicable licensure/certifications/inspections applicable to healthcare services or health equipment used in providing services and a review of the compliance plan and program, if they are in place, is available at an additional charge.. A formal report with recommendations is provided. Expanded or service-specific reviews are available upon request and priced accordingly Educational presentation to employees re: risk areas identified and necessary action for risk reduction Charge capture document design, education & implementation Documentation template design & implementation HIPAA Perform a review of a provider's/institution's/department's/billing company's HIPAA compliance status. As these reviews can range from simple to highly complex; covering one to all areas of the HIPAA requirements, the scope of the review will determine staffing needs and engagement cost. Educational presentation to employees re: risk areas identified and necessary action for risk reduction STARK Perform a review Perform a review of a provider's/institution's/department's compliance status with respect to the STARK regulations. Compliance services with respect to the Stark laws are available by request and with adequate pre-review notice, and as these reviews can range from simple to highly complex, the scope of the review will determine staffing needs and engagement cost. Educational presentation to employees re: risk areas identified and necessary action for risk reduction FDA/ICH Perform a review to determine compliance with FDA/ICH regulations within the clinical research arena, including but not limited to, SOP's, GCP's, GMP's, GLP's, IND/TIND,/NDA/IDE submissions, investigator brochures, drug labeling, pharmacovigilance/adverse event reporting/drug safety regulations, IRB compliance, adequacy of all documentation, study & source, and QA of CSU and CRA work. If Medicare beneficiaries are enrolled in any of the clinical studies, a review for compliance with Medicare's regulations within the clinical research arena is available as an add-on engagement A "mock" FDA/ICH visit "experience" is available as an add-on engagement. A review for HIPAA compliance within the clinical research arena is available as an add-on or stand alone engagement Educational presentation to employees re: risk areas identified and necessary action for risk reduction Additional services available
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