COMPREHENSIVE COMPLIANCE SERVICES

Compliant Revenue Optimization

  • Building and managing processes and teams to compliantly improve documentation and coding, yielding enhanced reimbursement and mitigated risk (“Compliant Reimbursement Optimization Council” or “CROC”)

  • Designing cutting-edge, high impact provider documentation and coding education programs which compliantly optimize revenue and further mitigate risk

Clinically Integrated Network (CIN) Compliance 

  • Structuring CINs to demonstrate indicia of integration meeting FTC standards

  • Forming and operating CINs in a compliant manner

  • Building compliance-savvy participant & payer outreach and engagement strategies

Medical Group Compliance

  • Compliance program effectiveness review/optimization
  • Leadership & staff education
  • Policy development
  • Risk assessment/work plan development
  • Out-source compliance leadership services
  • Investigations, including privacy/data security, documentation/coding & conflict of interest

Hospital and Health System Compliance

  • Physician arrangement/compensation fraud & abuse analyses; corrective action
  • Proactive/re-contracting physician arrangement monitoring tools (“smoke detectors”)
  • Compliance program effectiveness review/optimization
  • Leadership & staff education
  • Medical staff compliance issues, including credentialing, investigations and conflict of interest management
  • Policy development
  • Research compliance, including research billing compliance
  • Risk assessment/work plan development
  • Marketing & fundraising compliance counseling
  • Controlled substance diversion mitigation & investigations

Virtual Care/Telehealth Compliance

  • Optimizing workflows while mitigating risk
  • Compliance with licensure and reimbursement rules
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