Consulting Areas of Expertise
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Ongoing consultations in Medicare Finance, Compliance and Risk Adjustment are offered as part of our services and solutions. Should a client need specific assistance with issues related to Compliance CAPs, OIG, RADV, CMS regulations or reimbursements, our Director of Customer Care can arrange an initial complimentary conference call with one or more of our executive, on-staff industry experts.
Once a client’s issues and the complexities of a potential resolution are defined, consulting can be provided on an hourly, as-needed, or project basis. Consulting projects include, but are not limited to:
- HCC Data Flow Analysis and Best Practices Recommendations.
- Assistance in resolving IT issues related to CMS data files and information exchange with CMS.
- Workflow and risk assessment of client operations including analysis of possible data capture issues with the plan and data intermediaries.
- Analysis of low reporting IPAs or Medical Groups to review for systemic data issues and assist in enhanced data capture.
- Assistance with Claims Compliance issues such as on-site de-delegation, denial letter compliance, assistance in resolving workflow issues and establishing compliant operations.
- Mock CMS site visits to assist in assessment of internal operations and assist in preparation for CMS site visits. This includes many operational areas, such as plan or delegated claims, appeals & grievances, expedited initial determinations, membership, pre or post service denials.
- Assessment of Compliance Plan, Compliance Committee Structure and development of key reporting indicators.
- Consulting related to Implementation of CMS Fraud, Waste and Abuse requirements.