Investigating health care fraud is one of the highest priorities of state and federal governments as well as third party payors. Applied Management Systems (AMS) has a staff of lawyers and legal representatives available to provide hospitals with guidance and advice through the span of hospital compliance requirements for the myriad of regulations hospitals must be compliant with.
AMS is available to assist with the following needs in the area of compliance
- Plans, policies and procedures – Evaluate and critique existing and create new ones
- Standards of conduct and business practices
- Hotline and other reporting mechanism establishment
- Coding audit and documentation review
- Investigation and reporting protocol development
- Review and redesign encounter forms
- Staff training and certification
- Advance Beneficiary Notice requirements
- Physician documentation and reassignment rules
HIPAA
AMS also has a specialized segment of the compliance department pertaining to the Health Insurance Portability and Accountability Act (HIPAA). We are able to assess hospital departments in order to ensure they are in compliance with these regulatory established policies and procedures, and recommend a plan of action through which to achieve compliance.
HIPAA-specific services include –
- HIPAA training
- Assessment of compliance with confidentiality and release of information
- Security and electronic data interchange monitoring
- Strategy development for ongoing compliance