What does healthcare revenue integrity include?

Documentation and coding audits, medical necessity compliance, HCC risk assessments, regulatory updates and coding advisory support, and charge capture audits.

What is covered under government and payer audit response?

RAC, UPIC, and commercial audit appeals, Medicare and OIG self-disclosure assistance, statistical analysis and overpayment calculation, Independent Review Organization services, and Corporate Integrity Agreement support services.

What belongs in a compliance and internal audit program for healthcare organizations?

Program development and effectiveness assessments, program and enterprise risk assessments, education and training for staff, management, and the governing body, physician contract process and documentation assessments, work plan development and execution with project management, and fractional or virtual program support, including Compliance Overwatch.

What does 340B compliance and readiness involve?

HRSA audit response and readiness assessments, contract pharmacy compliance assessments, policy and procedure development, and internal auditing and monitoring work plan development.

Which litigation support services help during investigations and disputes?

Support for kickback and Stark Law violations, financial mismanagement reviews, response to government investigations, and expert witness services.

What do forensic accounting and investigations provide in compliance matters?

Internal investigations, asset tracing, financial analysis, expert testimony, transaction due diligence, and financial fraud prevention.

How do HCC risk assessments support accurate risk adjustment and compliance?

They evaluate documentation and coding related to hierarchical condition categories as part of revenue integrity activities.

What is medical necessity compliance in day-to-day operations?

Reviews that assess whether documentation supports services billed, within revenue integrity and audit activities.

What is included in telehealth and virtual services compliance support?

Program development and operations, regulatory updates, and documentation and coding reviews for virtual care.

What are independent monitorships in healthcare compliance?

Independent Review Organization activities and Corporate Integrity Agreement monitoring that help organizations demonstrate ongoing compliance.

Trusted Advisors in Healthcare Compliance & Litigation Support

Healthcare Compliance & Litigation Support

PYA offers a robust portfolio of regulatory compliance and investigative services. With a wide range of compliance expertise and industry experience, our team works alongside external counsel, organizational leadership, and front-line staff to mitigate and manage risk. Regardless of your healthcare setting, PYA brings value with practical insights, innovative problem-solving, and radical responsiveness.