our clients

Other Provider Types

Our large healthcare system clients are complex organizations that juggle the demands of multiple hospitals, clinics, and outpatient facilities, while also managing a network of affiliated physicians. These systems not only face the typical challenges of smaller hospitals but also operate in a highly regulated environment. They grapple with rising costs, declining reimbursements, and increasing competition, making financial sustainability a constant challenge.

Common Challenges

Ambulatory Surgery Centers (ASCs): Ambulatory Surgery Centers (ASCs) are required to comply with Medicare regulations, including proper documentation of surgical procedures and adherence to infection control standards. Risks involve billing for non-covered procedures, failure to meet accreditation requirements, and inadequate documentation, which can result in claim denials and penalties.
Behavioral Health Facilities: Behavioral health inpatient and outpatient treatment facilities must adhere to state and federal regulations, including proper documentation of treatment plans and outcomes. Risks include billing for non-covered services, upcoding, and failure to meet state licensure requirements, which can jeopardize reimbursement and program participation.
Critical Access Hospitals (CAHs): Critical Access Hospitals (CAHs) must adhere to specific Medicare Conditions of Participation (CoPs) designed to ensure access to care in rural areas. Risks include improper billing for swing bed services, failure to meet staffing requirements, and inadequate documentation of patient care, which can lead to audits and financial penalties.
Diagnostic Centers: Diagnostic centers are required to maintain compliance with federal and state regulations, including proper use of CPT codes and adherence to medical necessity guidelines. Risks involve overbilling, duplicate billing, and failure to meet accreditation standards, which can lead to audits and penalties.
Durable Medical Equipment (DME) Companies: DME companies face compliance challenges related to documentation of medical necessity and adherence to competitive bidding requirements. Risks include billing for unapproved equipment, lack of proper physician orders, and failure to meet supplier standards, leading to audits and financial penalties.
Imaging Centers: Imaging centers must comply with Medicare and Medicaid regulations, including proper documentation of medical necessity and adherence to CPT coding guidelines. Risks include billing for non-covered services, duplicate billing, and failure to meet accreditation standards, which can result in audits, claim denials, and financial penalties.
Independent Laboratories: Independent laboratories must comply with stringent documentation and billing requirements to avoid fraud and abuse allegations. These labs face risks related to improper coding, overbilling, and failure to meet Clinical Laboratory Improvement Amendments (CLIA) standards, which can result in penalties and exclusion from federal programs.
Long-Term Care Facilities: Long-term care facilities are required to meet federal and state regulations, including Medicare Conditions of Participation (CoPs) and quality reporting requirements. Risks involve billing for non-covered services, failure to meet staffing requirements, and inadequate documentation of patient care, which can jeopardize reimbursement and program participation.
Orthotics and Prosthetics (O&P) Companies: O&P companies must ensure accurate documentation and billing for custom devices to comply with Medicare and Medicaid requirements. Risks include improper coding, insufficient documentation, and failure to meet quality standards, which can result in claim denials and recoupments
Physician Corporations and Specialty Practices: Physician corporations and specialty practices are subject to compliance with Stark Law, Anti-Kickback Statutes, and proper documentation of medical necessity. Non-compliance can lead to significant financial penalties, reputational damage, and exclusion from Medicare and Medicaid programs.
Rehabilitation Facilities: Rehabilitation facilities must comply with Medicare regulations, including proper documentation of therapy services and adherence to medical necessity guidelines. Risks involve billing for non-covered services, failure to meet accreditation standards, and inadequate documentation, which can result in audits and penalties. Regulatory compliance in healthcare is critical to ensure adherence to the rules and regulations set forth by CMS, HHS OIG, State Medicaid, and other governing bodies. These regulations aim to mitigate payment and documentation risks across various provider types, safeguarding the integrity of Medicare and Medicaid programs.
Skilled Nursing Facilities (SNFs): Skilled Nursing Facilities (SNFs) must comply with federal and state regulations, including Medicare CoPs and quality reporting requirements. Risks include billing for non-covered services, failure to meet staffing requirements, and inadequate documentation of patient care, which can lead to audits and financial penalties.
Substance Use Disorder Treatment Centers: Substance use disorder treatment centers must comply with federal and state regulations, including proper documentation of treatment plans and adherence to confidentiality requirements under 42 CFR Part 2. Risks include billing for non-covered services, failure to meet accreditation standards, and inadequate documentation, which can lead to audits and financial penalties.
Telehealth Providers: Telehealth providers face unique compliance challenges, including adherence to HIPAA regulations and proper documentation of virtual visits. Risks involve billing for non-rendered services, failure to meet state-specific telehealth requirements, and inadequate documentation, which can result in claim denials and penalties.
Urgent Care Centers: Urgent care centers must adhere to compliance standards for billing and documentation, including proper use of CPT codes and medical necessity guidelines. Risks include upcoding, billing for non-covered services, and failure to meet state licensure requirements, which can lead to audits and financial penalties.

Our solutions are designed to help our clients

Compliance, Optimization, Health, Security

Regulatory Compliance: Our expertise in healthcare law and compliance can help our clients navigate complex regulations and avoid costly penalties. We can conduct risk assessments, develop compliance programs, and provide training and education to ensure adherence to all applicable laws.
Financial Optimization: Our revenue cycle experiences can help our clients improve revenue cycle management, reduce costs, and enhance profitability. We can optimize billing processes, negotiate contracts with payers, and identify opportunities for cost savings.
Population Health Management: Our population health management solutions can help our clients address social determinants of health, improve preventive care, and manage chronic diseases. We can leverage data analytics and technology to identify at-risk populations and develop targeted interventions.
Cybersecurity Protection: Our cybersecurity experts can help our clients safeguard sensitive patient data from cyberattacks. We can conduct vulnerability assessments, implement security measures, and provide training on cybersecurity best practices.

contact our team today

Let’s navigate healthcare challenges together.

Streamline compliance, optimize your revenue cycle, and achieve sustainable financial health.

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our clients

Other Provider Types

Common Challenges

Our solutions are designed to help our clients

Compliance, Optimization, Health, Security

contact our team today

Let’s navigate healthcare challenges together.

Services Awards

Great Doctors

Friendly Nurse

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