Post Acute Compliance Services
Our approach to compliance is objective, interdisciplinary, collaborative and comprehensive, bringing the right mix of qualified professionals to address your needs. Each work plan is custom designed to meet your specific needs within your time frame and budget.
Services include:
- Assessment of compliance risk
- Medical record/medical necessity audits
- Billing and coding review
- Detailed review of current issues resulting in denials
- Identification of potential problematic areas related to compliance and/or medical necessity
- Calculation of scope of risk and extrapolation for the appropriate segment of patient population
- Development of appeal documentation
- Development and implementation of successful, innovative corrective action plans, including documentation modification
- Clinical and medical staff education
- Appeal of loss of provider status
- Interfacing with legal counsel and payor source contractors
- Expert witness
Examples of our proven track record:
- Appeal and successful reinstatement of provider status
- Identification of weaknesses in addressing the Medical Necessity of admissions and establishment of ongoing internal monitoring processes
- Negotiation for multiple clients with extensive compliance issues resulting in overpayment; example: PAI coding error with estimated impact of $1M, negotiated to $250K
- Development of extrapolation methodologies for inpatient and outpatient rehabilitation/skilled nursing. Successful negotiation with FI for a reduction of $500,000 in payback
- Provision of physician education and ongoing documentation monitoring for physical medicine and rehabilitation physicians
- Clinical, physician and leadership education resulting in reported high satisfaction and understanding of critical content
Clinical Operational Assistance
Post Acute Advisors combines strong experience with innovative thinking to assess and implement practices that will improve the efficiency and effectiveness of your post acute clinical services. We are able to build the relationships and implement the change necessary to change positively impact the delivery of care and the bottom line.
Services include:
- Operational assessments to improve efficiency and effectiveness
- Interim management oversight
- Development and implementation of new programs/services
- Accreditation survey preparation
- Mock accreditation surveys
- Documentation development/transition to EHR assistance
- Clinical and medical staff training and education, including:
- Functional scoring training
- Interdisciplinary team building
- New regulations and staff role in demonstrating compliance
- Details of issues that have received denials from CMS external contractors
- Establishment of clinical outcomes systems
- Development and implementation of internal and external marketing plans
- Development of internal and external marketing and patient materials
- Development and implementation of patient satisfaction tools
- Expert witness
Examples of our proven track record:
- 100 percent success rate in obtaining Medicare certification for inpatient rehabilitation and skilled nursing programs
- Monitoring and improving staff productivity/ratios in line with national benchmarks and regulatory/compliance guidelines
- Immediate response to state survey results with implementation of education and documentation plan and reversal of negative results
- Successful modification/implementation to an EMR system to demonstrate regulatory guidelines
- Interim management to implement a complex (compliance) corrective action plan involving re-organization, staffing and delivery of inpatient rehabilitation, an extensive outpatient (therapy services) network outpatient rehabilitation, and skilled nursing therapy services
- 100 percent success rate in accreditation awards following preparation efforts
