Compliance and Auditing

Our business review and audit services can help you reduce your risks by identifying and correcting deficiencies. Complicated billing regulations, confusing coding rules, complex Medicare policies, fear-driven down coding. may all result in lost reimbursement, impacting your bottom line.

Cornerstone Medical Management is dedicated to providing physicians and practice managers with comprehensive solutions that span across all stages of the healthcare business cycle. Our team of professionals brings a wealth of experience and capabilities to effectively address the critical issues facing your practice.

Some of the services we offer include:

  • Development and implementation of a fully customized OIG compliance program
  • Conducting a review of the effectiveness of your existing compliance program and provide updates to your policies and procedures.
  • Providing staff training on your compliance program.
  • Development and implementation of a HIPAA privacy and security program.
  • Reviewing of existing HIPAA policies and forms.
  • Conducting comprehensive internal investigations of compliance violations.
  • Functioning as your compliance officer
  • Providing billing, coding and compliance seminars and presentations.

For health law firms:

  • Conduct interviews and internal investigations for your clients under attorney-client privilege.

Coding and billing requirements are complex. Keeping up with HIPAA, OIG, NCQA, CLIA, Medicare, Medicaid and other regulatory agencies can be overwhelming. Cornerstone employs Medical Compliance Specialists, Certified Professional Coders, Certified Professional Medical Auditors and providers of varying specialties in their business reviews

We realize that physician practices have increasingly strained resources. Our goal is to provide high-value solutions while maintaining affordability to our clients. An effective healthcare compliance program can help an organization spot errors in its processes, and prevent small problems from becoming large ones, especially in the area of billing to government healthcare programs.

Looking for a simple review of 10 charts per provider, a focused audit on a particular risk area, or support during a government investigation?  Our Business Review and Auditing services can help - whatever your need.  Protect your practice with a full compliance program or simply validate your documentation meets industry standards by selecting one of our business review packages shown below.

Option A - Clinical Auditing

The client forwards copy of the patient's records and the codes assigned to each chart.  Cornerstone staff will use the CMS Documentation Guidelines, and AMA CPT coding rules to determine the correct CPT code and modifier based on the physician's notes.  A detailed report and assessment will be submitted to the client showing a report of findings, recommendations and action items.

Option B - HIPAA Privacy and Security Audit 

With the implementation of the HITECH Act, PPACA and upcoming audits, HIPAA compliance has assumed greater importance.  The original HIPAA regulations laid the foundation for a national set of requirements to safeguard the privacy and security of individually identifiable health information.  More recent changes have expanded and modified the regulations and included a mandate for the Department of Health and Human Services to audit providers for compliance. 

Medical practices and business associates alike are required to become compliant with HIPAA regulations.  Some of the requirements include:

  • Informing patients about privacy practices
  • Securing paper and electronic patient medical records – both at rest and in transit
  • Conducting a thorough risk assessment of the confidentiality, integrity and availability of information held by the organization
  • Updating Business Associate Agreements
  • Developing policies for breach notification to patients and the media

Option C - The Baseline Audit

Cornerstone Medical Management staff will arrive on-site and provide a comprehensive compliance review of your office.  This review includes NCQA guidelines, OSHA, CLIA, HIPAA, OIG, Medicare and Medicaid rules and regulations.  The baseline audit provides an objective approach to determining if problems exist and provides a framework for developing a remedy for concerns.

Option D - The Comprehensive Compliance Plan

In addition to the Chart Review, HIPAA and Baseline Audit, Cornerstone Medical Management will develop and assist in implementing a comprehensive compliance plan that is tailored to meet the unique needs of your practice. As part of this plan, we can provide ongoing regulatory updates and recommend repeat chart reviews in order to achieve optimal risk management.  An effective healthcare compliance program can help an organization spot errors in its processes, and prevent small problems before they become large ones, especially in the area of billing to government healthcare programs.

The process of a compliance audit is simple and easy to arrange - think of it as a wellness visit for your office!

 

ICD-10 Readiness Assessments

Will you be ready? 

Documenting for ICD-10 is demanding.  Is your organization properly positioned to meet the ICD-10 deadline?  Compliance with ICD-10 will be critical to the continued success of all healthcare organizations beginning October 1, 2014. 

Cornerstone is dedicated to helping physicians protect their bottom line during this transition.

Identify where ICD-10 will impact you the most.  Check out our new Documentation Readiness Assessment Service and see how we can help you prepare.

 

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Consulting and Training

Cornerstone Medical Management offers on-site consulting services. Whatever your needs are, from billing policies, coding review, and office process review, our experienced staff can help you resolve your issues.

Cornerstone also hosts web-based and live training seminars on the hottest Billing, Documentation and Compliance-based topics.  Our one-hour Lunch-and-Learn series offers web-based training on relevant topics at an affordable price.  We also offer no-cost Lunch-and-Learn classes on FDM's features to provide additional training to our clients on functions and features that might be overlooked!  These free classes are open to all and include a 45-minute presentation and Q&A session. 

Click here for a schedule of upcoming events.

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Medicare and Medicaid Audit Review

Concerned about your Medicare / Medicaid billing?  The OIG is auditing providers and has recovered billions of dollars from providers for claims paid in error.  Our team can help you assess your audit risk.  Our audit team will review your clinical records, your existing OIG Compliance Plan, HIPAA Policy and Procedures and assess your readiness should you be audited.  We will identify any deficiencies in your office and provide expert assistance in correcting any errors discovered.

This confidential service is provided directly or through health care counsel if you have been notified of an impending audit.

Don't wait, worry and fret - find the answers to your questions!  Our medical audit consultants have expert training in all aspects of healthcare compliance. 

Common issues that can be addressed in a review or consultation include:

  • Medicare/Medicaid Billing, Coding & Documentation
  • Third Party Billing, Coding & Documentation
  • Incorrect or insufficient billing - including appeal assistance
  • Special Investigations Unit Visits
  • Recoupment Issues
  • Qui Tam or "Whistleblower"
  • ICD-9 and ICD-10 migration assistance
  • Other compliance concerns

For additional information  please contact us at 888.887.5259 or talktous@cstonemedical.com.

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Medical Billing Services

The service we provide allows your organization to focus on in-house patient care while our qualified staff constantly monitors the billing and payment follow-up. Outsourcing helps assure consistent billing and coding service.

  • We have proudly partnered with Medical Billing Solutions of Tennessee for all of our billing clients.
  • Practice management software provides you with full access to your patient information.  Always.
  • Dedicated account staff.  Your account manager and billing specialists are committed to helping you obtain the best reimbursement possible - in a timely manner.
  • Dependable follow-up.  We handle 100% of the follow-up activity and provide you with a monthly report of all aged, unpaid claims with the reason they are open and an expectation of when they will be resolved.
  • Consistent cash flow.  Outsourcing means your cash flow isn’t impacted by employee turnover, vacations, or sick leave. From submission to appeals, let our experts handle the details.
  • Proven Results.  Our dedicated staff and efficient processes will improve your cash flow!

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