Compliance & Audit Risk Management

The Office of the Inspector General has a clear mandate to actively hunt for providers and suppliers that are out of compliance, shut them down, recoup improper payments, and criminally prosecute the offenders. They are fueled with virtually unlimited money and armed with sophisticated data mining programs, undercover agents, and unprecedented inter-agency cooperation.

Bottom line: The likelihood of getting audited is higher than ever.

Staying afloat in an ocean of endless, constantly changing regulations is a daunting task.

During more than 20 years of operating our own healthcare businesses, we learned that the best way to manage audit risk is to build an uncompromising "Culture of Compliance" designed to integrate audit risk mitigation into every aspect of the practices' operations. Our healthcare consulting team will guide you to peace of mind through our custom-tailored pathway to a Culture of Compliance.

First, we will conduct an Evaluation of the current state of your practice. Based on our findings, we develop a custom action plan to address any weaknesses found. We will then guide your staff through the Integration of the plan. Finally, our healthcare consulting team will maintain an ongoing Review to ensure that the program is working as intended.

1. Evaluation

The Evaluation phase begins with an honest, thorough look at the current state of the practice. As experienced outsiders, we are able to look at the firm objectively and hollistically, enabling our team to get a truly independent understanding of your operations.

Mock audit and site inspection
Comprehensive assessment of documentation and EMR systems
Chart, coding and billing review
Interviews with owners, managers, clinicians, and office staff
Assessment of information flow between the different departments in the practice
Assessment of your current understanding of the relevant regulations that govern the practice
Review entirety of the practice's policies and procedures

2. Development

In the Development phase, our team will closely analyze our findings and work with your entire staff to create a realistic, targeted action plan that leverages the strengths of the practice to help fix its shortfalls.

Review detailed findings with practice management team
Prioritize shortfalls based on contribution to audit risk
Develop specific, measurable goals to address the key issues
Set the timeline for the integration process
Improve existing documentation, and if necessary, create new documentation tools
Revise, and if necessary, rewrite policies and procedures

3. Integration

Once the plan is set and the backbone elements (policies, procedures, documentation, etc.) are in place, our team will help guide the practice through the Integration phase.

Work with practice management and stakeholders to oversee change process
Conduct mandatory in-office training for all staff

4. Review

It's easy for staff to switch back to old habits, so organizational change must be monitored over time. This is why the Review phase is an important component of our service. Regular check-ups will help assure that the committment to compliance remains true.

Monthly check-ins with practice management to track performance against short and long-term goals
Tweaking of policies, procedures and documentation to ensure maximum effectiveness
Regular updates on changes in relevant government regulations
Quarterly chart and documentation reviews
Ongoing mandatory staff training