Celtic Consulting

  • “…one effective tool is the performance of regular, periodic compliance audits by internal or external auditors.”
    The Health Care Director’s Compliance Duties: A Continued Focus of Attention and Enforcement | A Joint Publication from the Office of the Inspector General, U.S. Department of Health and Human Services and the American Health Lawyers Association
 

Compliance Solutions Consulting Services

Independent (External) Compliance Auditing: The OIG (Office of the Inspector General) recommends an in-depth Compliance Audit be performed annually as part of an effective Corporate Compliance Plan. A full Compliance audit will include analysis of the following:

  • Admission Documents
  • Medicare Program Integrity
  • Medical & Clinical coding including supportive documentation
  • Financial and Billing aspects 
  • Managed Care/Medicare Advantage and other insurance covered entities

After audit is performed on-site, a formal report will be forwarded and an associate will be available to discuss our findings and recommendations. The organization is then responsible for implementation decisions and the ultimate management of the clinical program. More frequent, Quarterly Audits, are recommended for areas that do not meet compliance expectations. These audits will include a review of a smaller sample of records and the associated documentation.

OBRA Survey and Certification: Mock Survey Traditional/QIS, including preparation, staff training and identification of potential deficiencies.

Corrective Action Plan Development: Celtic Consulting can collaborate with the organization in development of action plans to address statement of deficiencies for State survey, complaint surveys and MDS surveys to address areas of non-compliance; may include QAPI development and evaluation.

Identification of Organizational Financial Risk Indicators: Through regular auditing, interaction with staff, and overview of organizational processes, financial risks including: jeopardized revenue, lost or missed opportunities to capture additional revenue, civil monetary penalties and fines, can be identified.

Rehab Documentation Compliance: Includes examination of supportive physician documentation, compliance with CMS regulations for evaluations, treatment plans and certifications. Observation for reasonable and necessary treatment, supporting the need for a skilled therapist.

Corporate Integrity Agreement Auditing & Reporting: Assisting your organization throughout the process and providing formal reports to submit to the federal agency imposing the agreement, giving you and your team peace of mind knowing that your reporting requirements meet Federal expectations for correction and improvement.