Medicare, Tri-Care, Federal Employee Health Plan Post Payment Audit Defense
Federal health plan payers including Medicare, Tri-Care and contractors administering benefits for Federal Employee Health plans are actively engaged in post payment analysis of provider claims. We can provide you with timely assistance during the record request phase of the process that often leads to avoidance or mitigation in the amount of alleged error. If you have proceeded beyond this phase and have received an audit result and a demand for repayment, we can provide the necessary assistance with your appeal. Federal regulations provide an administrative appeal process that, with assistance, can lead to a substantial reduction in the error rate and the resulting refund demand. These appeal processes have deadlines and submission standards. Get the help you need to avoid the stress and expense associated with these audits.
Commercial Carrier Post Payment Audit Defense
Commercial payers are also actively engaged in post payment analysis of provider claims. We can provide you with timely assistance during the record request phase of the process that often leads to avoidance or mitigation in the amount of alleged error. If you have proceeded beyond this phase and have received an audit result and a demand for repayment, we can provide the necessary assistance with your appeal. Each carrier has their own appeal process. Failing to submit a timely appeal can result in having to return money that you may not owe. Get the help you need to avoid the stress and expense associated with these audits. We can also assist with providing local counsel where state law issues arise.
False Claims Act Defense
Because of the damages and penalties that can arise for violations of the False Claims Act, immediate assistance and intervention on your behalf is critical to obtaining a satisfactory resolution. We have the coding, documentation, clinical and statistical experts necessary to provide the most aggressive defense.
HIPAA Privacy and Security Compliance
Remaining compliant with the privacy and security components of the Health Insurance Portability and Accountability Act (HIPAA) just got harder with passage of the HITECH Act. Every provider needs to review and update existing privacy and security policies, add policies for breach notification, and update business associate agreements to remain compliant with recent changes to HIPAA. We have distilled the regulatory changes and can provide specific “how to” instruction to allow you to remain compliant with minimal effort.
Corporate Healthcare Transactions
Hiring a doctor? Buying a practice? Starting a marketing program? Adding other disciplines to an existing practice? These are but a few of the common transactions that, if not properly analyzed and structured, can have disastrous results later on. Get help before making a costly mistake.
Health Care Compliance Consulting, Risk Management, and Compliance Planning
If your interest is in understanding your risk areas and avoiding the potential of a future audit or refund demand, we can serve as a resource to ensure that you have the information necessary to operate compliantly. Did you get a billing tip from another provider? Did you get conflicting advice from a carrier? Not sure what is right or wrong? Afraid of making a costly mistake? Allow us to evaluate your practice and identify all of the relevant policies that you are required to adhere to. We can also assist with provider/staff education, auditing, and monitoring that will permit you to remain compliant. Maintaining your profitability as well as your level of compliance while still seeing patients is possible with the assistance we can provide.