Compliance Advisory

PYA’s Approach

PYA offers a robust portfolio of compliance services. Our consultants possess a diverse range of compliance expertise and experience. PYA is committed to working alongside organizational leadership and front-line staff team members to mitigate risk and maximize overall compliance practices for organizations. PYA provides comprehensive compliance services:

340B Compliance Assessment

  • HRSA Audit Readiness Assessment
  • Contract Pharmacy Compliance Assessment
  • Policy and Procedure Development
  • Internal Auditing and Monitoring Work Plan Development

Behavioral Health Compliance

  • Evaluation of required documentation to ensure compliance with governmental regulations
  • Experience with overlapping mental health issues
  • Medical record documentation assistance that adheres to compliance requirements
  • Experience in specialty areas, such as: Geriatric Psychiatry, Adolescent Psychiatry, Substance Abuse, Eating Disorders, Inpatient Psychiatric, Intensive Outpatient Program, Post-Traumatic Disorders, Outpatient Services, Partial Hospitalization Program
  • Complete HIPAA Compliance Risk Analysis which utilizes PYA’s four-part analysis Privacy, Security, Breach Notifications, and Transactions and Code Sets

Coding & Billing Compliance

  • Documentation & Coding Compliance Reviews including Interpretation of Payer Coding & Billing Policies
  • Internal Coding Audit or Support including Provider/Auditor Dispute Resolution
  • Departmental Structure & Communication
  • Coding & Billing Policy & Procedures

Compliance Program Implementation, Assessment, & Support

  • Compliance Plan Effectiveness Assessment
  • Compliance Risk Assessment
  • Compliance Educational Resources & Bootcamp
  • Virtual Compliance Officer and Executive Management Support
  • Compliance Program Core Requirements Assistance

Internal Audit Outsourcing

  • Risk Assessment
  • Internal Audit Plan Development and Implementation
  • Management and Governance Education
  • Co-Sourcing or Outsourcing

IRO Services

  • Acute Care Facilities, Physician Groups, Home Health, & Behavioral Health Services
  • Specified Claims Review of Coding Accuracy, Billing Compliance
  • Related Education

Medical Necessity & Care Management

  • Patient Status Evaluation & Observation Services
  • NCDs, LCDs, and CoP Documentation Compliance
  • Hospital Readmission Reduction Program (HRRP)
  • Cardiac Procedures
  • Universal Bill (UB-04) and Remittance Advice
  • Clinical Trial Protocols

Outsourced Compliance Program

  • Assistance with Compliance Program Core Requirements
  • Executive Management Support

Patient Safety Organization (PSO)

  • PSO Compliance Assessments
  • Patient Safety Evaluation System (PSES) Implementation, Training, and Assessments

Physician Analytics

  • E/M, Procedural, and Time Study Benchmarking
  • Reimbursement Reviews
  • Proxy Work RVUs Development

Post-Acute Care

  • Transitional Care Management
  • MDS 3.0 Quality Measures Review and Performance Improvement
  • Coding and Billing Compliance

Quality

  • Hospital Inpatient MS-DRG/Outpatient APC ICD-10 CM/PCS Coding Quality Assessments
  • Hierarchical Coding Categories (HCC) Risk Assessment
  • Value-Based Purchasing (VBP) Assessments
    • Patient Safety Indicators (PSI)
    • Hospital-Acquired Condition (HAC)
    • 30-Day Readmission
    • 30-Day Mortality
  • Physician Quality Reporting System (PQRS) Reporting
  • Quality Resource Utilization Report (QRUR) Interpretation
  • MIPS/MACRA Readiness
  • Clinical Co-Management Agreements

Revenue Cycle

  • Patient Access & Upfront Collections
  • Coding Analysis
  • Charge Capture Process Assessments
  • Billing Services
  • Reimbursement
  • Charge Description Master (CDM) Review

Technology

  • Meaningful Use Attestation Assistance
  • Electronic Health Record (EHR) Consultation
  • Information System Utilization Assessment
  • HIPAA Security Risk Analysis (Privacy, Security, and Breach Notification)
  • IT Risk Management

Compliance Advisory
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