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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.
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
Healthcare Price Transparency
- No Surprises Act
- Price Transparency
- Federal Funding and Accountability and Transparency Act (FFATA) reporting
- Negotiated Pricing
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Transparency in Coverage (Payers)
Internal Audit Outsourcing
- Risk Assessment
- Internal Audit Plan Development and Implementation
- Management and Governance Education
- Co-Sourcing or Outsourcing
Independent Review Organization 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
Pharmacy Compliance
- Pharmacy benefit management (PBM) audits
- “Dispense as written” (DAW) assistance
- Prescription documentation
- Appeal assistance
- CMS policy interpretation
- Post-audit defense support
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