Compliance Support Solutions
The ability to understand information as it relates to a specific healthcare issue requires in depth knowledge of reimbursement and regulatory principles, MS-DRG and HCPCS and CPT coding guidelines, hospital charging processes and clinical operations. A great deal of the time, this knowledge is so specialized – and changing so rapidly – that your current staff may not be fully knowledgeable about this area.
At SunStone, our extensive knowledge and experience in working with various billing and coding compliance initiatives is available to you as needed. Without hiring full-time staff, or tasking current staff to become experts in this specialized area, you can engage us as needed and have the certainty of knowing you have met the most stringent criteria for compliance.
Compliance consulting is a flagship service for us. Our team has been at the forefront of assisting providers with every major compliance initiative by the Department of Justice (“DOJ”). Our experience includes:
- DRG Window/72 hour rule
- DRG Pneumonia
- Operation Bad Bundle (Lab Unbundling)
- Infusion Therapy/Chemotherapy Unbundling
- E&M – Modifier 25
- RAC readiness assessments
- Independent Review Organization
- Annual documentation, coding & billing reviews
- Expert testimony
- Litigation support
- Voluntary disclosures
Our consultants have extensive experience with all aspects of the compliance environment. We have performed data mining, detailed claims and medical records analyses, quantified and extrapolated the financial impacts, assisted clients and legal counsel on strategizing settlements, and assisted with corrective action for risk areas, including staff education.