Healthcare Consulting & Management

Challenges addressed

• Survey findings and deficiency citations
• Outdated or incomplete policies and procedures
• HIPAA Privacy and Security gaps
• Lack of a documented compliance program

Typical deliverables

• Compliance gap assessment and remediation roadmap
• Up-to-date policies, procedures, and forms
• Audit-readiness checklist and pre-survey review
• Ongoing corrective action monitoring

Challenges addressed

• Unfavorable payer terms and reimbursement rates
• Missed contract renewals and terminations
• No central repository for executed agreements
• Unclear obligations across vendor contracts

Typical deliverables

• Payer contract review with redlines and recommendations
• Organized contract repository and renewal calendar
• Fee schedule comparison and rate analysis
• Contract obligation tracking dashboard setup

Challenges addressed

• Slow enrollment delaying billing and revenue
• Lapsed credentials causing payer issues
• Manual, error-prone verification workflows
• Fragmented credentialing files across locations

Typical deliverables

• Centralized, audit-ready credentialing files
• Recredentialing and expirable tracking calendar
• Enrollment status reporting by provider and payer
• Documented verification workflow

Challenges addressed

• Documentation gaps that support downcoding
• Upcoding or unbundling exposure
• Inconsistent coding across providers
• Findings from payer or OIG audits

Typical deliverables

• Focused coding and documentation audit report
• Corrective action and education plan
• Coding workflow and charge-capture recommendations
• Ongoing monitoring of coding accuracy

Challenges addressed

• Rising denial rates and avoidable write-offs
• Recurring denials from the same root causes
• No visibility into denial trends
• Reimbursement leakage across the revenue cycle

Typical deliverables

• Denial trend dashboard and root-cause analysis
• Targeted denial-prevention action plan
• Key revenue-cycle metric reporting
• Ongoing reimbursement monitoring