Most of the consultative services offered are either Administrative or Clinical Quality Assurance functions or actions. Typical services may include such activities as:
- A comprehensive review of medical record organization, legibility, documentation, clinical findings, diagnostic and procedure coding compatibility, and policy compliance with appropriate third party payors.
- A complete and thorough analysis of the provider's MIS, internal QA mechanisms, billing system, claims resolution, accounts reconciliation, audit trail, licensing requirements, and staffing compliance.
Once the review of analysis is complete, alternatives are presented, and recommendations are suggested for operation enhancement. As a by-product of a QA consultation or in a focused analysis of billing procedures, our outside evaluations of your current operations often enhance your future billing opportunities as well.
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The following tasks are typical of past projects:
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- Third party policy interpretation and verification
- Analysis of operational liabilities
- Installation of internal Quality Assurance systems
- Contracts for ongoing QA external auditing and corrective action plans
- Billing system analysis and customized billing enhancements
- Coding consultations
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- Audit preparation/Corrective action plans
- Licensing applications and provider enrollment
- Claim resolutions
- Specialized development of agency policy and procedure manuals
- Expert witness preparation and legal support strategy development and coordination
- Settlement consultation, representation, and negotiation
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