HEALTHCARE CONSULTING

As healthcare organizations react to risk adjusted and/or quality-based reimbursement mechanisms (BPCI-A, VBP, MSSP, MSPB, etc) and begin to assume more risk in payor contracting, they must develop core competencies and adapt to produce claims data to accurately depict the true acuity and burden of illness for each patient and to predict future resource requirements for individual patients and entire populations.

Competencies around this include precise clinical documentation attached to clinical workflow; technology solutions that are accurate and provide the required compliance coding; regular feedback on clinical documentation quality by credentialed personnel; and a systemized process that includes training to assess and improve coding quality.

Our comprehensive and holistic approach to CDI is matched with a customized plan for every client, wherever they are on their journey to Risk Capability for their organization.

Our Clinical Documentation and Coding Integrity team work extensively with healthcare providers in all areas including appropriate coding, clinical documentation and billing of services across the full continuum of care settings and associate payment mechanisms. We guide our clients on their path to Risk Capability with urgent challenges around Compliance.

These include general, focused and/or attorney privileged matters in support of ongoing compliance initiatives, alongside reviewing and identifying required corrective measures or defense against third party assertions; Statistical sampling, payment error quantification, payment error extrapolation and disclosures when needed and serving as the Independent Review Organization (IRO) for a number of organizations with reporting requirements under Corporate Integrity Agreements as a result of entering into settlement agreements with government agencies; and establishing, evaluating and/or implementing compliance policies and safeguards based on regulatory requirements, which covers designing compliance plans as well as providing ongoing assessment activities to verify the operationalization of the adopted policies.

With increasing complexity emerging around the post-acute healthcare space, our team not only delivers support services tied to operationalizing healthcare entities, but also serves as an advisor to clients as they work to bridge processes with actionable claims submissions data and AR collections.

Providing an industry software platform, troubleshooting support, custom reporting, analyses and training support are a handful of additional services we provide.