Compliance

The very nature of healthcare regulation and compliance is rapidly changing, leaving providers in a challenging position.

Issues including Manual Medical Review, Automatic ADR’s and PPS have providers seeking guidance and best practices, all while facing increased competition in their communities. To survive they must remain in-step with today’s demands as well as prepare for the emerging trends that will shape future regulatory environment.

CRS ensures that facilities maximize reimbursement and are protected from financial and legal liabilities. Working with facility staff, we develop systems for sound documentation, risk assessment, reporting and report preparation, auditing and coding, and strategic planning.
Compliance Services Provided:

Rehab risk assessments (assist in identifying areas of risk (industry risk, Medicare or other third party reimbursement risks, practice risk) and prioritization for establishing plans of corrections and ongoing monitoring)

Compliance plan development (written code of conduct, standards and procedures)-to allow for establishment of compliance standards and practices from which to base auditing, monitoring, education and enforcement

Internal monitoring and auditing – of identified areas of risk to ensure compliance and problem resolution

Training and education – to ensure employees have the information necessary to provide quality care including adherence to all applicable clinical, regulatory and legal standards.

Reporting, investigation and enforcement standards – open communication and discussions related to compliance issues and concerns, confidential reporting lines, and thorough tracking and investigations related to reported concerns with applicable disciplinary enforcement

Medical record audits / monitoring of OIG, ZPIC, RAC, CERT, MAC, NCD/LCD activity – to identify areas of risk/ opportunity for improvement; pro-active monitoring of audit and contractor agencies to assist in risk identification as it related to documentation, coding, billing.

Denials management – support and education throughout the ADR / denials process including multi-level appeals

Documentation quality education and training resources – education and training resources related to documentation quality as it pertains to justification of medical necessity and skilled provision of services, regulatory guidelines, NCD’s/LCD’s, audit agency activity and focus areas.

Quarterly Newsletter – ongoing-up to date notifications and education compliance outsourcing and oversight services (ongoing regulatory monitoring and auditing activities) – to provide timely communication and education related to changes in regulations and industry standards

Monthly “maintenance” support plans via email and phone –related to any of the topic areas above.