Medicaid / Medicare Compliance
In a constantly changing business and regulatory landscape, the health care industry and its mandates and regulatory requirements are constantly evolving. Carter Davis Healthcare has helped health care providers comply with the myriad of state and Federal laws regarding fraud and abuse, self-referral, reimbursement, fraud and abuse, licensing and certification, HIPAA and privacy, risk management, medical staff, and the business aspects of health care for over two decades. We draw upon extensive experience dealing with the complex health care provider system, private and government payors, and state and Federal agencies to advise individual providers, physicians, and other provider group practices, ambulatory care facilities, hospitals, nursing facilities, assisted living facilities and other individual, group and institutional health care providers.
After an assessment of the organization, Carter Davis Healthcare will conduct the following exercises:
- Review of the Medicaid / Medicare Compliance process.
- Survey preparation for staff.
- Standards Training established.
- Review of Environment of Care and Life Safety Codes.
We want to help your organization use existing tools to meet the standards of care without re-inventing the tool. Sometimes, realignment is all that it takes to improve results.
Our goal is yours – to offer the best services possible to your client base, with the most efficiency and effectiveness.
Regulatory Compliance and Reimbursement Issues
Regulatory compliance is key to avoiding governmental enforcement actions and assuring reimbursement from governmental and other payors. Regulatory concerns include fraud and abuse, Stark and other self-referral issues, and HIPAA/privacy issues. We can assist with identifying compliance risks, developing compliance plans, structuring business arrangements and responding to governmental concerns. Our understanding of state and Federal health care program requirements related to Medicare certification and reimbursement, anti-kickback, self-referral and tax-exempt issues, can address all of these issues both defensively in the planning stage and in response to identified problems.