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Medical Compliance Services

In 2017 it was estimated that Medicare overpaid around a half BILLION dollars in claims. 1 This has led to a significant increase in provider audits and monetary recoupments, not just by Medicare, but Medicaid and Commercial Payers as well. Most recoupments were due to insufficient documentation to justify medical necessity for the billed procedures.

The motto of the Gold Star Medical Compliance consultants is “Let us audit you before THEY do”. Certified and expert consultants will review your charts and documentation for deficiencies that could cause your claims to be recouped on audit. We will also review your claims for correct coding and billing procedures, and help you minimize errors in the future.

Compliance is not just about documentation, HIPAA and OSHA. While these are major players in the compliance game, CMS has mandated since 2010 that Medical Compliance programs be implemented for every clinic. There are seven key elements to a Medical Compliance Program. One of these is having a WRITTEN Policy and Procedure Manual, and another is providing ongoing compliance training for your medical providers and administrative staff.

The Gold Star Medical Compliance Team can put together a Custom Clinic Compliance Manual and follow up with the mandatory compliance training you need. This may include classes (either on site or via live webinar) on documentation, billing, HIPAA Privacy and Security, OSHA, Human Resources, Sexual Harassment and Workplace Violence. We can also come to your office to do a full onsite baseline audit of all your compliance programs and requirements.

1 https://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/CERT/Downloads/2017-Medicare-FFS-Improper-Payment.pdf