Compliance with ever-changing laws and regulations has never been more important – or more challenging - for healthcare than today. These changes create new questions, yet clearly expand risks at the individual and enterprise level. We combine extensive knowledge and resources to help medical practices and their hospital partners navigate and thrive in this environment.
Coding and Billing Compliance
- Coding and medical record audits
- Billing compliance program planning, implementation and monitoring
- Existing compliance program risk/effectiveness assessment
- RAC, ZPIC, MIC and other 3rd party audit assistance
- Pre/post acquisition risk assessments of medical practices and ASCs
- Independent Review Organization (IRO)services to comply with your Corporate Integrity Agreement (CIA)
- Stark, Kickback and False Claim risk assessment and reduction
- Training and education programs
Compliance Program Services
Protect your practices from expanding legal and financial risks. With MMA’s Compliance Program Services, you can protect your organization by identifying and assessing high-risk areas; implementing an updated compliance program; auditing and monitoring; and developing a knowledgeable staff.
Our compliance team works with you to define and achieve your objectives: from implementing a turn-key program – to performing focused compliance audits – and everything in between.
- Turn-key programs for new organizations
- Comprehensive program oversight
- Initial and annual program assessments
- Routine and problem-focused audits
- Staff orientation and training
- Compliance officer support
- Billing Compliance
What you can expect from us:
- Lasting results from actionable plans that combine strategy, systems and staff development. We know that people, not recommendations get things done.
- Complete compliance life-cycle management services including plan development, education, auditing and monitoring that mitigate your risk.
- Highly flexible approach to client engagements…from a one-hour telephone consult to management of recurring audit projects requiring vendor certification.
- Confidentiality. Our standards on confidentiality meet or exceed HIPAA requirements.
Our Regulatory Compliance Risk Assessment focuses on risks related to billing, patient privacy, electronic security, personnel, workplace safety, and other key regulations. Services included in the assessment will include the following:
- Initial discussions with key leadership to clarify the assessment process, better understand existing compliance organizational structure and initiatives, and identify any specific areas of concern.
- Review existing written billing, HIPAA and OSHA compliance programs/plans that the organization has formally adopted – whether managed by the organization or a third-party (i.e., billing service).
- Review of brief questionnaire to be completed by the organization prior to onsite visit. The questionnaire will assess staff awareness of and compliance with key organization and regulatory requirements.
- Desktop analysis of key compliance performance indicators (KCPI). We will review standard billing reports to identify high risk coding and billing activities at the practice and provider level.
- Onsite meeting with key staff to assess the compliance processes. The meeting will include an interview and review of supporting documentation.
- Preparation of a Regulatory Compliance Risk Assessment report that summarizes our findings and recommendations.
- Onsite meeting with key leadership to discuss the Regulatory Compliance Risk Assessment findings and recommended plan of action (POA) to reduce exposure risk.
1OIG fraud alerts, Medicare/Medicaid billing guidelines, Stark II, Anti-Kickback Statutes, False Claims Act, RAC Approved Issues, Federal Sentencing Guidelines, HIPAA Privacy/Security/Standard Transactions and Code Sets, OSHA, EEOC, ADA and ADAAA, Title VII, ADEA, EPA, IRCA, EPPA, FCRA, GINA, CCPA, ERISA, FLSA, COBRA, GA O.C.G.A. Sections 34-8/33-24, GA New Hire Reporting Program, GA DOL Employment Security, GA DOR/IRS reporting.