Regulatory Compliance

As health care organizations develop and implement a regulatory compliance program in accordance with OIG guidance, they often forget the most critical component of the government’s recommendations: that the program is ongoing, quality focused, and an integral part of their organization.

Our team of highly specialized health care consultants work with your organization to develop and implement a comprehensive, well-integrated compliance program. Solutions include:

Compliance Gap Assessments

Not only do we review your organization's written policies and procedures, but we also test their completion or effectiveness. This all-inclusive approach enables us to provide you with a maturity rating that communicates the level of implementation of each of the OIG’s seven elements of effective compliance.

Compliance Risk Assessment

A risk assessment is pivotal for an organization to determine where to focus its compliance efforts. We interview key stakeholders to identify the areas of concern for reputational, financial, and regulatory compliance. We then rank the risk areas and work with management to determine the high-risk areas for focus in the upcoming year.

Compliance Audit and Monitoring

We can help you develop audit and monitoring programs designed to mitigate risk. Our experience allows us to design audits that focus on specific risk areas—not just a conventional, all-purpose audit. Based on the results, we help you formulate action plans related to special investigations and overpayment refunds. Corrective action plans may include discussion of how to score or evaluate the results. In addition, we can help you design audit programs to support quality assurance programs related to coders and other billing staff.

Compliance Investigations (Forensic Review)

You constantly receive notifications from outside agencies to perform audits of medical documentation and coding—which is why we analyze and re-review the results of your organization’s payer audits and investigations. In addition, we can help determine how to audit the reported incident or concern. Our approach is unique: We review the payers’ findings, analyze a comparative period, interview providers and staff to ascertain facts related to the inquiry, validate extrapolations, and prepare written reports of findings.

Independent Review Organization

Moss Adams is an Independent Review Organization (IRO). Our consultants work with a variety of health care entities to complete the claims review portion of a Corporate Integrity Agreement (CIA) with a focus on paid claims with a calculated reimbursement error rate.

Key Compliance Indicator Assessments

Key compliance indicators help your organization measure activity by using numerical factors or trends to monitor areas of risk—before they become systemic or problematic, resulting in overpayment. Our team can help implement key indicators to assess your current situation, determine problem areas, set goals, and track performance.

In addition, we consult in the following compliance-related areas:

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