Services

Coding and Billing Compliance Services That Hold Up Under Audit

Proactive compliance support — RAC pre-audit and appeals, IRO reviews, program audits, and documentation assessments — to identify risk and protect your organization.

35+
Years of Expertise
1989
Serving Healthcare Since
U.S.
Based, Credentialed Staff
6
Specialty Service Lines

Overview

Identify Risk Before It Finds You

HMI’s specialists help healthcare organizations meet and maintain compliance with Medicare rules and regulations through comprehensive review, practical guidance, and process-improvement support. From Recovery Audit Contractor (RAC) activity to Corporate Integrity Agreement obligations, we help you understand where exposure exists and how to address it.

Whether you need to respond to a RAC demand letter, satisfy IRO requirements under a CIA, audit your compliance program, or strengthen clinical documentation, our credentialed consultants bring the regulatory depth and real-world experience to guide your team — and the education to keep improvements in place.

What’s Included

Comprehensive Compliance Support

RAC Pre-Audit & Appeals

A comprehensive review of RAC findings cited in the demand letter against the medical record and final billed claim to determine whether documentation and billing are appropriate — with support for appealing denied claims or services where warranted.

Independent Review Organization (IRO)

The claims reviews required under a Corporate Integrity Agreement (CIA), including reports for the OIG, corrective-action recommendations, and staff training on current coding and billing methodologies.

Compliance Program Audit

An on-site audit of your current compliance program — questionnaires, program-manual and recordkeeping review, a sample review of records and bills, and key-staff interviews — concluding with an exit conference and recommendations.

Clinical Documentation Assessments

An assessment of your documentation processes and medical-record review for completeness across physician and clinical staff, with education provided to all staff.

Coding Compliance Review

Inpatient, outpatient, and E/M coding reviewed for compliance, with follow-up reviews and education to sustain accuracy.

Education & Training

On-site and off-site education for facilities and providers (provider-based, teaching, or independent practice) on healthcare compliance, coding, and billing.

Why It Matters

Why Compliance-Minded Organizations Choose HMI

Reduce Audit Exposure
Find and fix documentation, coding, and billing risk before it becomes an audit finding or repayment demand.
Respond to RAC with Confidence
Experienced support reviewing findings and building well-supported appeals to protect appropriate revenue.
Meet CIA / OIG Obligations
Dependable IRO claims review and reporting that satisfies Corporate Integrity Agreement requirements.
Build a Stronger Program
Program audits and education leave your compliance function measurably stronger than we found it.
“

HMI has been a great partner with MedStar Washington Hospital Center for many years. We can always count on them to support us on projects small to very large — delivering consistent, honest results and thoughtful, targeted education for our physicians.

Purvi JaniAVP, Reporting & Revenue Cycle · MedStar Washington Hospital Center

How We Work

How We Approach Compliance

01
Assess
We review the records, claims, program documentation, or RAC findings relevant to your situation.
02
Analyze
We determine whether documentation and billing are appropriate and where compliance exposure exists.
03
Recommend
You receive findings, corrective-action recommendations, and, where applicable, appeal support.
04
Educate
Targeted staff and provider education helps keep your organization compliant going forward.

Frequently Asked Questions

Compliance Services, Answered

Can HMI help us respond to a RAC demand letter?
Yes. We comprehensively review the RAC findings against the patient medical record and final billed claim to determine whether the documentation and billing are appropriate, and we can assist in appealing the denial of a claim or specific services.
Do you perform IRO reviews under a Corporate Integrity Agreement?
Yes. Our specialists perform the claims reviews required under your CIA, prepare the reports required for the OIG, recommend corrective actions, and provide staff training on current coding and billing methodologies.
What does a compliance program audit include?
An on-site review of your current program — questionnaires to your compliance office and administrator, a review of the program manual and recordkeeping, a sample review of records and bills, and interviews with key staff — followed by an exit conference and recommendations.
Can you help strengthen our clinical documentation?
Yes. We assess your documentation processes and review medical records for completeness across physician and clinical staff, and we provide education to all staff.
Are your compliance consultants credentialed?
Yes. Our U.S.-based specialists hold industry credentials such as RHIT, CCS, CPC, and CHC, and bring deep, current knowledge of Medicare rules and regulations.

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Stay Ahead of Compliance Risk

Protect Your Organization
with a Proactive Partner

Talk with HMI about RAC support, IRO review, a compliance program audit, or documentation improvement.

Schedule a Consultation (844) 446-9176