Compliance

Services

340B Compliance Assessment

• HRSA Audit Readiness Assessment
• Contract Pharmacy Compliance Assessment
• Policy and Procedure Development
• Internal Auditing and Monitoring Work Plan Development

Behavioral Health Compliance

• Evaluation of required documentation to ensure compliance with governmental regulations
• Experience with overlapping mental health issues
• Medical record documentation assistance that adheres to compliance requirements
• Experience in specialty areas, such as: Geriatric Psychiatry, Adolescent Psychiatry, Substance Abuse, Eating Disorders, Inpatient Psychiatric, Intensive Outpatient Program, Post-Traumatic Disorders, Outpatient Services, Partial Hospitalization Program
• Complete HIPAA Compliance Risk Analysis which utilizes PYA’s four-part analysis Privacy, Security, Breach Notifications, and Transactions and Code Sets

Coding & Billing Compliance

• Documentation & Coding Compliance Reviews including Interpretation of Payer Coding & Billing Policies
• Internal Coding Audit or Support including Provider/Auditor Dispute Resolution
• Departmental Structure & Communication
• Coding & Billing Policy & Procedures

Compliance Program Implementation, Assessment, & Support

• Compliance Plan Effectiveness Assessment
• Compliance Risk Assessment
• Compliance Educational Resources & Bootcamp
• Virtual Compliance Officer and Executive Management Support
• Compliance Program Core Requirements Assistance

Healthcare Price Transparency

• No Surprises Act
• Price Transparency
• Federal Funding and Accountability and Transparency Act (FFATA) reporting
• Negotiated Pricing
• Transparency in Coverage (Payers) 

Internal Audit Outsourcing

• Risk Assessment
• Internal Audit Plan Development and Implementation
• Management and Governance Education
• Co-Sourcing or Outsourcing

Independent Review Organization Services

• Acute Care Facilities, Physician Groups, Home Health, & Behavioral Health Services
• Specified Claims Review of Coding Accuracy, Billing Compliance
• Related Education

Medical Necessity & Care Management

• Patient Status Evaluation & Observation Services
• NCDs, LCDs, and CoP Documentation Compliance
• Hospital Readmission Reduction Program (HRRP)
• Cardiac Procedures
• Universal Bill (UB-04) and Remittance Advice
• Clinical Trial Protocols

Outsourced Compliance Program

• Assistance with Compliance Program Core Requirements
• Executive Management Support

Patient Safety Organization (PSO)

• PSO Compliance Assessments
• Patient Safety Evaluation System (PSES) Implementation, Training, and Assessments

Pharmacy Compliance

• Pharmacy benefit management (PBM) audits
• “Dispense as written” (DAW) assistance
• Prescription documentation
• Appeal assistance
• CMS policy interpretation
• Post-audit defense support

Physician Analytics

• E/M, Procedural, and Time Study Benchmarking
• Reimbursement Reviews
• Proxy Work RVUs Development

Post-Acute Care

• Transitional Care Management
• MDS 3.0 Quality Measures Review and Performance Improvement
• Coding and Billing Compliance

Quality

• Hospital Inpatient MS-DRG/Outpatient APC ICD-10 CM/PCS Coding Quality Assessments
• Hierarchical Coding Categories (HCC) Risk Assessment
• Value-Based Purchasing (VBP) Assessments
  • Patient Safety Indicators (PSI)
  • Hospital-Acquired Condition (HAC)
  • 30-Day Readmission
  • 30-Day Mortality
• Physician Quality Reporting System (PQRS) Reporting
• Quality Resource Utilization Report (QRUR) Interpretation
• MIPS/MACRA Readiness
• Clinical Co-Management Agreements

Revenue Cycle

• Patient Access & Upfront Collections
• Coding Analysis
• Charge Capture Process Assessments
• Billing Services
• Reimbursement
• Charge Description Master (CDM) Review

Technology

• Meaningful Use Attestation Assistance
• Electronic Health Record (EHR) Consultation
• Information System Utilization Assessment
• HIPAA Security Risk Analysis (Privacy, Security, and Breach Notification)
• IT Risk Management