HealthCare Consulting Solutions

Compliance Related Services

Comprehensive Billing and Charging Compliance Assessment

The Comprehensive Compliance Assessment integrates our technical, operational and clinical expertise in coding, documentation, charging and billing practices, to determine whether hospital, clinics and/or physicians are at risk for Medicare noncompliance issues as reported on their UB-92s and HCFA 1500s claims based upon documentation within the medical record and the hospital's chargemaster. The assessment incorporates critical elements targeted as part of the OIG's 2005 and 2006 Work Plans.

Additional compliance-related services include:

  • Corporate Compliance Plan Development and Review
  • Physician Coding, Documentation and Billing Audits with Education
  • Home Health, Hospice and Skilled Nursing Documentation, Coding and Billing Audits with Education
  • Comprehensive Chargemaster Assessment with Education
  • Follow-up implementation assistance and review is an additional option

Inpatient/DRG and Outpatient/APC Coding with Education

The Inpatient/DRG and Outpatient/APC Coding Audit with Education is designed to evaluate the accuracy and appropriateness of the diagnosis and procedural coding based upon physician's documentation to ensure compliance with CMS coding and documentation guidelines while identifying potential reimbursement or process improvement opportunities. Results per case are identified and a recalculation is determined for each case to identify overpayment or underpayment. Coding education for the staff follows the audit to improve coding and to share the latest, most up-to-date information on coding and documentation protocols.

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