Healthcare Regulatory Compliance Services

In fiscal year 2015, the Office of Inspector General hit healthcare providers for more than $3 billion in recovered receivables. CMS Recovery Audit Contractors (RAC’s) uncovered nearly $3.4 billion in provider overpayments in 2014. As a healthcare organization, you also face increased scrutiny from CMS, Medicaid Integrity Contractors (MIC’s), and Zone Program Integrity Contractors (ZPIC’s) – all looking for possible abuse and fraud.

No organization can afford to be caught up in the ever widening net of these regulatory agencies. Ensuring your organization’s compliance means increasing your focus on internal compliance processes, but that can be difficult to do if available resources are limited.

Hayes’ credentialed experts can help you address compliance issues and tighten your compliance profile with an array of services in the following areas:

Compliance Program Development: We work with you to plan, implement, and optimize a comprehensive compliance program focused on:

  • Risk assessment, mitigation, and avoidance
  • Auditing
  • Interim compliance office management
  • Compliance Program development
  • KPI development
  • ICD-10 Code Education and Training Services
  • Development of an Enterprise Terminology Management strategy

Auditing: We help you align your auditing program with the requirements of OIG, ICD-10, CMS and other third parties. Our experienced consultants will guide you in the most effective ways to conduct, document, and report on your audit activity.

Clinical Documentation Improvement (CDI): Our experts will assist in optimizing your CDI program to ensure accurate reporting of diagnoses and procedures, reducing compliance risk, minimizing audit vulnerabilities, and providing insight into quality of care issues.

Education and Training: To remain compliant and ensure appropriate reimbursement, your clinicians, coders, and staff must stay up to date on current requirements. Hayes provides customized training and curriculum development in a variety of settings and Learning Management System (LMS) platforms.

Computer Assisted Coding Services (CAC): Solutions are adopted to improve medical coding workflows, increase medical coding accuracy, and balance medical coding resources to focus on more volume and complex cases. CAC solutions must fit within larger health information technology (IT) strategies. To accomplish this, healthcare organizations must obtain a working knowledge of key CAC solution features and functions. Our CAC experts can assist your organization with support for CAC implementation, workflow optimization and also provide consultative oversight for the review, determination, and purchase of appropriate Computer Assisted Coding (CAC) product.

Information Governance Services: Governance of the sources and uses of HIPAA mandated healthcare data is key to your compliance program. Our experienced consultants will help you establish data standards that are essential for such initiatives as Accountable Care, Clinical Quality Measures, Value Based Purchasing, Health Information Exchange, and Population Health Management. Our expert terminologists can help you define an Enterprise Terminology Management strategy and develop Value Sets/Code Groups to enable data analytics.

The Hayes ICD-10 team was excellent. Their expertise in physician documentation improvement, ICD-10 optimization and training was timely, effective and successful. They excelled at communicating with our physicians which enhanced the process tremendously.

Dalinda Gonzales

Supervisor - Revenue Capture and Support, MD Anderson Cancer Center

To learn more about how Hayes can help you with your compliance needs, REQUEST INFORMATION.

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