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Risk Management

Healthcare is evolving rapidly and compliance to both Federal and State regulations can be a daunting task for doctors and their staff. With ongoing healthcare administrative changes, you need a compliance strategy that can provide you with quality education and knowledge to ensure your office is both profitable and compliant. We provide physicians and staff training in correct coding, billing and documentation.

 

Comprehensive Compliance Audit Program

This program consists of periodic reviews of your clinic’s coding, billing, documentation, and HIPAA policies. Reviews are conducted on an ongoing basis to evaluate the implementation of the compliance program. Policies and protocols will be implemented to standardize compliance processes, and a customized manual is developed in support of the compliance program.

The development of an effective compliance program involves:

  • Written policies and procedures to assist compliance with laws and regulations
  • Ongoing training and education to ensure awareness of compliance requirements
  • Auditing and monitoring to ensure the program is operating effectively
  • Corrective action to address any identified shortcomings in the program
  • Reduction of billing errors and optimization of proper claim payment
  • Maximized revenue and minimized financial loss
  • Detailed understanding of Medicare and commercial carrier documentation requirements
  • Coding proficiency and accuracy
  • Enhanced patient care
  • Peace of mind
  • Security Risk Analysis (Initial & Ongoing) $1,200+ value


Fee: Monthly Fee of $199.00 (24 month service agreement)

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Clinic in Crisis Program

The Office of the Inspector General (OIG) consistently calls out the chiropractic profession on inadequate and inaccurate documentation, subjecting practices of all sizes to audit situations. This program is specifically for offices undergoing a post-payment audit, where overpayment recoupment demands are being made or fraudulent activity is alleged.

A comprehensive review of all communication from the carrier regarding the audit and associated charts will be conducted. A rebuttal report will be generated and step-by-step guidance throughout the appeals process will be provided. There are four levels to the appeals process:

Redetermination (carrier level)
Reconsideration (Qualified Independent Contractor)
Administrative Law Judge Hearing
MAC Hearing (Medicare Appeals Council)

Risk Management & Compliance Expert, Dr. Ted Arkfeld and Healthcare Law Attorney and Chiropractor, Dr. Steven Conway handle communication on your behalf between your practice and the carrier, all the while providing expert opinion throughout each level. They will also work with the carrier to establish a Corporate Integrity Program for offices required to do so.

In addition, periodic reviews of your clinic’s coding, billing, documentation, and HIPAA policies will be performed. Reviews are conducted on an ongoing basis to evaluate the implementation of the compliance program. Policies and protocols will be recommended for implementation to standardize compliance processes, and a customized manual is developed in support of the compliance program.
The recovery of a clinic in crisis involves:

  • Consultation and facilitation throughout the appeals process, including that of a healthcare attorney
  • Development and implementation of a Corporate Integrity Program (if required)
  • Written policies and procedures to assist compliance with laws and regulations
  • Ongoing training and education to ensure awareness of compliance requirements
  • Auditing and monitoring to ensure the program is operating effectively
  • Corrective action to address any identified shortcomings in the program
  • Reduction of billing errors and optimization of proper claim payment
  • Maximized revenue and minimized financial loss
  • Detailed understanding of Medicare and commercial carrier documentation requirements
  • Coding proficiency and accuracy
  • Enhanced patient care
  • Peace of mind
  • Security Risk Analysis (Initial & Ongoing) $1,200+ value


Fee: Monthly Fee of $479.00 (24 month service agreement)

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Additional Risk Management Client Benefits:

  • Benefit Program (Courses & Business Resources) ($300 value per provider per contract year)
  • Client Discount on Seminars
  • Risk Management Town Hall (Monthly Virtual Group Coaching/Collaboration)
  • Individual Practice Coaching
  • Unlimited Access to Risk Management Online & On Demand Courses
  • Discounts on Select Online Courses
  • Special Rate on Clinical Decision Support Tool $49/month ($100 savings/month)

 

 

Security Risk Analysis

Complete assessment of all your practices technology to comply with the HIPAA security rule (45 C.F.R. §§ 164.302 – 318.). The Security Risk Analysis identifies the vulnerabilities to the security of electronic Protect Health Information (ePHI,) threats that can act on the vulnerabilities, including the likelihood and the impact if that occurs. The Security Management Process standard in the Security Rule requires organizations to implement policies and procedures to prevent, detect, contain, and correct security violations.” (45 C.F.R. § 164.308(a)(1).) Risk analysis is one of four required implementation specifications that provide instructions to implement the Security Management Process standard.

Fee: $1,200

Ongoing Security Risk Analysis

Monthly maintenance of your Security Risk Analysis to ensure continued compliance.

Fee: $49.00 per month. (24 month service agreement)

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