Compliance Services

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).

To be truly effective, your medical compliance program must:

  • 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 organizations like yours get healthcare compliant and stay compliant. Working with you, we’ll develop a tailored, measurable compliance program for your organization that will enable you to ensure you’re compliant with the Center for Medicare and Medicaid Services (CMS guidelines) and other governmental regulations.

Our medical compliance services include:

  • Documentation Reviews

    Our certified professionals review your documentation and medical coding services to ensure they’re appropriate and meet the requirements issued by CMS and other governmental regulations. We review it with an eye toward determining if the 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.

  • Coding Audits

    The purpose of this review is to help you identify areas of documentation improvement. We use a proprietary coding audit tool, similar to one approved by the Office of Inspector General, which assigns an accuracy rating to coding compliance issues identified. Medical record documentation, along with associated charge capture 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 and corrective action plan to help you maintain healthcare compliance going forward.

  • Due Diligence Reviews

    Our experienced coding and billing experts provide Due Diligence Support Services including random sampling, detailed audit analysis of medical record documentation and billing data and financial impact analysis. Our Due Diligence Services provide private equity firms and organizations with the support and analytical services needed to properly assess practices and groups for acquisition.

    Educational and Training Services

    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 non-physician practitioner guidelines. We also tailor our presentations to provide specialty-specific medical coding guidelines including NCCI edits and appropriate modifier use.

  • Corporate Compliance Program

    We can develop and implement a medical compliance program to ensure your organization adheres to protocols and procedures related to HIPAA compliance, privacy rules, security policies, OMIG, OIG, appropriate medical record documentation, coding, billing, and claim processing guidelines. Our expert team will develop tailored policies, procedures, and manuals to support your organization’s compliance needs

  • Investigations and Compliance Advisory

    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 in navigating 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.

    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.

The time to get compliant – and stay compliant – is now.

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