Our Services

Managed Care Audit Expertise

Navigating Compliance Challenges, Maximizing Revenue

In the realm of healthcare revenue management, compliance audits are vital for operational smoothness and financial integrity. We specialize in navigating this intricate landscape, ensuring adherence to regulations and seamless operations. We offer a suite of services to streamline revenue cycles, reduce denials, and improve financial health.

We excel in understanding evolving healthcare compliance and analyzing historical data, and trends. Our unique strength lies in providing actionable insights, not just audits. This ensures accurate claims filing through pattern recognition. Partner with us for fortified revenue cycles!

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Our Approach

Our Approach

Healthcare Services
Adherence Regulations
Chart Audits
Data Improvement
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    360-Degree Healthcare Compliance Audit Services

    Discover unparalleled healthcare compliance audit services that leave no aspect unchecked. From historical record evaluation to real-time claim monitoring, we guide you through every compliance step. Our holistic approach safeguards your revenue cycle by identifying and addressing potential pitfalls before they impact your practice.

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    Adherence to Regulations

    Stay aligned with evolving healthcare regulations and payer guidelines. Our compliance experts are dedicated to maintaining your practice's compliance with the latest mandates. Partner with us for meticulous claims submission that adheres to all rules, ensuring a seamless and compliant process.

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    In-Depth Chart Audits

    Uncover hidden insights through our thorough chart audits. We meticulously analyze documentation, coding methods, and reimbursement trends in historical charts. Advanced coding techniques reveal patterns and potential issues, enabling proactive solutions for enhanced compliance. Actionable Reports and Recommendations. Our comprehensive reports offer more than just problem identification.

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    Data-Driven Continuous Improvement

    Experience the power of data-driven insights. We use analytics technology to uncover trends and anticipate compliance challenges. Empower your practice with real-time information for strategic changes that enhance revenue cycle efficiency and ensure lasting regulatory compliance.

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OUR Audit Cycle

Four Phases of Compliance

Phase 1. Preparation-Setting the Stage : Lay the foundation for a successful compliance audit. Define the audit scope, allocate necessary resources, collect relevant data, and create a comprehensive audit plan.

Phase 2. Performance-Thorough Evaluation : Execute the audit plan with precision. Analyze data, identify patterns, review documents, and ensure coding accuracy to uncover compliance deviations.

Phase 3. Reporting-Clear Findings Communication : Compile audit findings into a comprehensive report. Present detailed issues, actionable recommendations, best practices, and visualized data for transparent communication.

Phase 4. Follow-Up-Sustained Improvement : Monitor recommended changes' implementation, assess their effectiveness, establish a feedback loop, and facilitate continuous learning for ongoing compliance enhancement.

Our Compliance Auditors

Role of Health Care Compliance Auditors

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Planning Audits

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Executing Audits

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Insightful Analysis

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Tailored Solutions

  • Planning Audits

    We begin by thoroughly planning each audit, and understanding your unique needs and compliance risks. This shapes our focused audit approach.

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  • Executing Audits

    With a solid plan in place, we meticulously execute the audit. We delve into documentation, workflows, and data analysis to assess your operations' compliance.

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  • Insightful Analysis

    Our auditors carefully analyze findings, pinpointing non-compliance areas and process inefficiencies. These insights drive strategic improvements.

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  • Tailored Solutions

    Working alongside your team, we create customized plans to address gaps and enhance compliance. Our solutions are practical, effective, and aligned with your goals.

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Our Servies

Efficient Healthcare Revenue Management

Navigating the intricacies of healthcare revenue management requires precise payment reviews. Our specialized team ensures providers receive fair compensation by meticulously assessing payments and adherence to agreements.

Comprehensive Adherence Process : We rigorously analyze payment records in comparison with contracts, guaranteeing compliance with terms. Our experts delve into contract specifics, cross-referencing claims for accurate payment.

Claim Submission Optimization : Beyond surface-level checks, we uncover discrepancies, ensuring proper reimbursement based on allowable rates. Inconsistencies are addressed to optimize service reimbursement.

Our Servies

MIPS and MACRA Reporting

Navigating the complexities of quality reporting programs such as the Merit-based Incentive Payment System (MIPS) and the Medicare Access and CHIP Reauthorization Act (MACRA) is a challenging task for healthcare providers. Our comprehensive reporting services aid providers in meeting reporting requirements, avoiding penalties, and optimizing incentives.

Penalties and Incentives : We provide meticulous reporting services that track and calculate MIPS scores and MACRA incentives accurately. By staying up-to-date with the latest regulatory changes, we ensure that your organization receives the incentives it deserves and avoids penalties associated with non-compliance.

Negotiation Insights : Our reporting isn't just about meeting requirements—it's about leveraging data to your advantage. We provide valuable insights into your organization's performance, which can be utilized as bargaining chips during negotiations with payers, ultimately leading to more favorable contracts.

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Our Servies

Client-Verified Accuracy

Accurate coding and billing are pivotal for successful revenue cycle management. We take immense pride in our commitment to precision, and our efforts are validated by the high accuracy rates confirmed through meticulous audits conducted by our client's internal audit teams.

CRigorous Internal Audits : Our processes are designed to meet the highest standards of accuracy. We welcome rigorous internal audits conducted by our clients' teams, which consistently confirm the accuracy and compliance of our coding and billing practices.

Client Satisfaction : Our client-side audit teams have consistently affirmed accuracy rates ranging from 97% to 98%. These impressive figures underline our dedication to precision and our ability to consistently deliver results that exceed expectations.

Our Expert

Expert Analyst Team & Technology Integration

Certified Account Managers : Our team is led by certified account managers who possess a deep understanding of healthcare compliance and revenue cycle management. Their expertise guides the entire audit process, ensuring comprehensive analysis and adherence to industry regulations.

Thorough Analysis : Our meticulous analysts scrutinize claims, documentation, and coding practices to uncover discrepancies, errors, and compliance risks, ensuring a comprehensive evaluation.

Cutting-Edge Coding : We incorporate the latest CPT and ICD codes, CMS guidelines, and industry standards in our training programs, keeping our analysts updated on coding practices and compliance.

Practical Insights : Real-world audit experiences enrich our training, equipping our team to identify trends, patterns, and emerging compliance risks.

Enhanced Skills : Continuous training sharpens our analysts' critical skills in chart analysis, coding accuracy, documentation review, and adherence to payer guidelines.

Professional Growth : Beyond compliance, we nurture our team's professional growth, ensuring passionate analysts are at the forefront of compliance expertise.

  • - Contact us today and take the first step toward a more profitable and compliant future.
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