Compliance
Our highly experienced consultants work with you to create solutions that fit your regulatory needs. Even through some compliance issues are readily identified, other compliance maters may require specific training, education, and research.
The breath of compliance issues can include the development or improvement of compliance plans and programs; internal coding; regulatory audits, identification, and quantification of issues for self-disclosure; regulatory and credentialling issues; clinical staffing and care plans; accreditation assistance; Independent Review Organization (IRO) reporting; and the investigation under Due Diligence for acquisitions.
Compliance Program Development and Implementation
We work with healthcare organizations to design and implement compliance programs tailored to fit the organization’s unique culture, structure, and operations while following the OIG’s guidance on “Operating an Effective Compliance Program.” The compliance program is developed or modified to include the organization’s Code of Conduct with a primarily focus on:
- Prevention
- Detection, and
- Application of Corrective Actions.
Specific compliance services include:
- Compliance Officer Advisory Assistance
- Interim Compliance Officer and Compliance Analyst Staffing
- Review, Modify or Develop Policies and Procedures, including the Code of Conduct
- Compliance Training Materials Development
- Compliance Training
- Internal Audit and Risk Assessment
- Functioning as an IRO or providing preparedness assistance for IRO reviews.
Internal Audit and Risk Assessments
Internal Audits and Risk Assessments are an integral part of an organization’s compliance program, which helps the entity identify and address critical areas impacting clinical, financial, and operational compliance risks. Kohler HealthCare works with organizations to:
- Develop mock surveys for accreditation and risk assessments
- Review, update and align policies and procedures with processes
- Conduct documentation, medical necessity, and coding reviews
- Coding, billing, and reimbursement reviews
- Develop or modify compliance plans
- Develop and conduct customized compliance training to mitigate any risk identified.
Independent Review Organization (IRO) and Corporate Integrity Agreement (CIA)
Kohler HealthCare has the knowledge, skills, and experience to provide pre-IRO readiness services or to serve as the IRO. We have provided IRO services for a variety of healthcare organizations including; hospitals; physicians; pharmacies; medical device companies; rehabilitation centers; and skilled nursing facilities.
As an IRO, our range of consulting services include:
- Compliance Program Pre-and-Post IRO Review dependent on the term of the Agreement
- Develop and implement an IRO work plan in accordance with the Agreement requirements
- System and Transaction Reviews
- Focused Arrangement Reviews
- Coding and Billing Reviews
- Policy and Procedure Reviews
- Compliance Training and Awareness
In addition, we have worked with many clients to manage the various internal projects to prepare for the IRO review by evaluating and improving processes to meet the agreement requirements, training, reporting, and submission timelines as required by the Agreement. IRO readiness is an important step to consider when preparing for the IRO review.
Mergers and Acquisitions / Due Diligence
Kohler HealthCare works with organizations by providing financial and operational due diligence, including financial documents review; performing focused operational investigations such as: coding, medical record documentation reviews, payer contracting and reimbursement reviews; billing reviews; clinical are risk assessment; and identifying risks and gaps in the processes of the target entity. The combined reviews are packaged and presented to aid the acquiring organization in making an informed decision regarding the compliance and financial risks of the target organization and to anticipate what may need to be resolved upon completion of the acquisition.
Organizations: Skilled Nursing Faculties, Home Health Agencies, Medical and Surgical Practices, Urgent Care Centers, Acute Care Hospitals, Pharmacy, laboratories, Dentistry, Physical Therapy and Ambulatory Surgery Centers.
Accreditation Assistance
Accreditation is more than the pursuit of healthcare excellence. Accreditation confirms your organizational commitment to compliance and drives continuous quality improvement. Whether it is a State regulatory body, The Joint Commission, AAAHC, AAAASF, CARF, ARMS, or NCQA, Kohler HealthCare Consulting offers a collaborative and educational approach to survey preparedness that assists organizations to understand their internal strengths and areas of performance improvement.
Our consultants have demonstrated successes in assisting organizations through the entire accreditation process, from pre-survey document review, on-going preparedness, mock surveys, through operational support during the actual survey. We employ a “walk with me” approach to assist facilities during the survey path.
Our advisory services continue after the survey is complete. KHC partners with your organization in Corrective Action Plan development, implementation, and monitoring. Our clients’ accomplishments in achieving accreditation success are based on our targeted and thorough approach in project management and performance reporting of large-scale initiatives.
Our clients include Hospitals, LTACH, SNF/rehab facilities, Health Centers, ASCs, Federal Qualified Health Centers, and Home Health/Hospice settings.
Specialty Coding and Documentation Audits
KHC has garnered deep and broad experience performing Facility and Professional Coding audits in a wide variety of medical specialties and healthcare environs. These audits involve all types of health organizations and specialties claims with the goal of determining compliance with documentation and coding standards regulations and payer requirements, including any missed revenue opportunities identified during the audit process. Intelicode© is the audit sotiware that KHC utilizes as the backbone for our professional coding audits and reporting.
Our coders are AAPC and/or AHIMA certified with extensive experience in facility, professional fee, and risk adjustment coding and consulting across a wide range of specialties. KHC consultants assist clients in developing coding solutions to not only improve quality, reduce risk, accelerate revenue, and optimize reimbursement while helping to identify changes necessary for more efficient operations.
KHC offers experienced health care professionals with the necessary tools to assist providers in evaluating, measuring and monitoring processes while complying with all regulations. Our coding professionals provide training assistance on a broad range of topics including:
- Coding and Documentation Audits
- National Correct Coding Initiative Edits Assistance
- Medicare/Billing Claims Audits/Use of NCCI
- MS-DRG Validation
- E/M Coding Reviews
- LTAC-DRG Validation
- PDPM SNF Nursing and Therapy Validation
- Medical Necessity Documentation Reviews
- Inpatient Short Stay and Observation Reviews
- EMR Implementation/Conversion Assistance
- Regulation/Compliance Policy and Guidelines Reviews
- Physician Education and Training
- Quarterly or Annual Monitoring/ Audits
Effective use of technology is a foundation to us. Much of the KHC work is being performed remotely through direct access into an Electronic Medical Record (EMR) system. KHC has experience with many information systems, including Epic, Cerner, Meditech, McKesson, NextGen, Athena Health, Allscripts, ARIA, MDAudit, E-Clinical Works, Clinicient, WebPT, and Wound Expert.
A representative sampling of the specialty area that KHC has conducted coding reviews include: Primary Care, Pediatric, Family Medicine, Behavioral Health (Psychiatric), Medical and Radiation Oncology, Cancer Centers, Trauma, Endocrinology, Internal Medicine, Orthopedics, Physical Therapy, Pain Management, Palliative Care, Acupuncture, Surgery, Urology, Wound Care, Ophthalmology, Dermatology, Otolaryngology, Cardiovascular, Neurology, Women’s Health, Pediatrics, Hospitalists, Emergency Medicine, Intensivists, Radiology, Transplant, Non-physician Providers, and Dental.