Compliance Services

HMI specialists provide comprehensive review, guidance, and process improvement instructions regarding meeting and maintaining compliance with Medicare rules and regulations. In addition, HMI provides assistance in Recovery Audit Contractor (RAC) pre-audit or appeals and assist in claims adjustment for all payors.

				
			
Compliance Services

Compliance Services

Education and TrainingOur consultant specialist can provide education and training both on-site and off-site on various topics for facilities and/or physicians (provider-based, teaching or independent practice).

Compliance Program AuditAs part of this program, HMI will conduct an on-site audit of the provider’s current compliance program. The review will include submission of HMI questionnaires to the Compliance Office and Administrator, or other designated personnel for response, a review of the program manual and recordkeeping process for providers required activities relating to the providers compliance program, including results of internal audits. The audit also includes a sample review of patient records and corresponding bills for compliance with current coding and billing guidelines, and interviews with key staff responsible for compliance program activities. At the conclusion of the on-site review, HMI will be available for an exit conference with designated hospital staff to review findings, discuss recommendations and/or correct action plan.

Recovery Audit Contractor (RAC) Preaudit or Appeal Services Our coding specialists will perform a comprehensive review of the RAC findings cited in the demand letter, patient medical record, and corresponding final billed claim to determine if the hospital documentation and/or billing information is appropriate. Where applicable, this service can be expanded to assist the hospital in appealing the reason for denial of entire claim or specific services.

Clinical Documentation Assessments and ReviewOur consultant specialist can provide an assessment of the process as well as medical record review for completeness of physician and clinical staff for documentation. Education can be provided to all staff.

Independent Review Organization (IRO) Claims ReviewOur consultant specialists will perform the claims reviews required under the Client’s Corporate Integrity Agreement (CIA), prepare required reports for the Office of Inspector General (OIG), make recommendations for Client’s corrective action plan and provide necessary staff training and education on current coding and billing methodologies. We also assess the providers billing and coding practices and compliance obligations under the CIA and Medicare rules and regulations.

Review of Coding For inpatients, outpatients, and E/M to assure compliance. Follow-up reviews are carried out with education.