Legal, Compliance & Coding

Legal, Compliance & Coding

THS will provide clients with healthcare regulatory and transactional advice and counsel on a range of industry specific issues. THS will provide a Comprehensive assessment of current corporate compliance program including structure and policy, strengths and weakness of program with recommendations to Board. THS will partner with the clients providers to ensure accurate, complete, and consistent coding practices for all providers in the Group. This includes proactive review of medical and surgical coding, completing a correct coding initiative at Group and Provider level, and conducting compliance risk analysis focused on coding anomalies.

Service Description
Compliance Training: Compliance Plan, HIPAA, Sexual abuse, Fraud / Abuse Develop and deliver initial and on-going annual staff and physician training on compliance related topics: HIPAA, harassment, fraud, and OSHA.
Risk Management Risk management program by developing processes for incident identification and reporting, methods for identifying and addressing potential tort claims, and policies by which a patient may be dismissed from care or refused care.
Malpractice Review Annual risk management assessment of group and coordinate a malpractice insurance review
Organizational / Governance structure Implementation of an organizational structure, and written bylaws, policies, procedures and protocols to facilitate the efficient and legal operation
Contract execution/consummation Assist in consummating such contracts as Manager and OC together may deem necessary or advisable for ancillary medical items and services, affiliation agreements and other material agreements for OC, including contracts and agreements with the Centers for Medicare and Medicaid, private health insurance carriers and other third party reimbursement entities to provide for reimbursement of patients for services provided by the group.
Consultation Report to and consult on an ongoing and regular basis, and not less frequently than on an annual basis, concerning these functions and compliance.
Coding Audits/Oversight Respond to all third party payer audits and inquiries related to coding/billing compliance issues and appeal if necessary
Contracts for Services at Clinic Contracts for Services at Clinic
Third Party Reimbursement Contracts Third Party Reimbursement Contracts
Government Regulations Government Regulations
OC Compliance Plan, Hotline and Training OC Compliance Plan, Hotline and Training
Coding Compliance / Audits Implement & execute coding compliance plan/policy which includes conducting internal Coding Compliance Audits accompanied with individual provider education meetings; any necessary ad hoc audits are also included
Coding Assessments Coding and posting of all surgical cases by certified coding staff; coding staff also assist business office staff with coding for insurance pre certifications and denials
Compliance Training: Conflicts of interest, HIPAA, Sexual Harassment, Fraud / Abuse
E/M Coding Training A 90 minute introductory educational session for physicians and PAs related to Federal Documentation Guidelines and other pertinent Orthopedic coding issues
Property Liability
Profession (Malpractice) Liability
Legal Services- Ad Hoc
 


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