Today's local, state and federal healthcare regulations are too complex – and the potential penalty for not complying too great to trust your medical compliance program to anyone but the very best. That's why some of New York's leading healthcare institutions trust the compliance professionals at RR Health Strategies (RRHS).
Ensure that all individuals in your organization observe pertinent laws and regulations in the performance of their work.
Articulate a broader set of ethical standards that are well understood, and adhered to, within your organization.
At RRHS, we have a proven track record of helping practices like yours get healthcare compliant and stay compliant. Working with you, we'll develop a tailored, measurable medical compliance program for your practice that will enable you to ensure you’re compliant with the Center for Medicare and Medicaid Services (CMS guidelines) and other governmental regulations.
Our certified professionals review your documentation and medical coding services to ensure they're appropriate and meet the requirements issued by the CMS and other governmental regulations. We review it with an eye toward determining if the professional services provided are supported by the documentation present in the medical record. All services rendered are assessed for appropriate medical documentation requirements and code selection.
The purpose of this review is to help you identify areas of documentation improvement. We use a coding audit tool, similar to one approved by the Office of Inspector General, which assigns a point value to coding compliance issues identified. Medical record documentation, along with associated charge documents and/or billing forms are reviewed and compared to the codes billed or to be billed. Based upon the issues identified, we provide appropriate recommendations to help you maintain healthcare compliance going forward.
To help ensure your practice remains in compliance, RRHS conducts compliance education In-Services for providers and ancillary staff that address such topics as Medicare Teaching Setting Guidelines, Evaluation and Management Services (E&M) and documentation guidelines, appropriate documentation and coding compliance practices and nonphysician practitioner guidelines. We also tailor our presentations to provide specialty specific medical coding guidelines including NCCI edits and appropriate modifier use.
We can develop and implement a medical compliance program along with providing education for staff training to ensure your organization adheres to protocols and procedures related to HIPAA compliance, privacy rules, security policies, appropriate medical record documentation coding, billing review and claim adjudication.
When your medical practice requires a third-party perspective – either because you're looking to reduce your administrative expenses or because you've been mandated to submit to an outside compliance review – RRHS is there. Our compliance professionals work with experienced healthcare attorney and integrity monitor Geoffrey R. Kaiser of Rivkin Radler to be your resource and ensure healthcare regulatory compliance with state and federal mandates.
Our experience in conducting investigations and our understanding of healthcare practice management and regulatory compliance provides our clients with valuable perspectives in support of defense and response strategies. Our services range from performing internal investigations to assisting clients navigate the requirements of Corporate Integrity Agreements (CIA) to acting as the Independent Review Organization (IRO) mandated by a CIA and charged with an objective assessment of client operations.
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