The ACE Approach
Compliance is not always about a wrong that was done intentionally. It’s about the prevention of innocent mistakes. You can rely on our check and balance system to help you avoid the serious danger of healthcare fraud. Penalties for unaddressed billing mistakes can run as much as $11,000 per claim form! An active compliance plan is the only real defense. Working with healthcare attorneys, we combine your policies with our knowledge of Medicare regulations.
To ensure that your compliance plan is active we recommend that you perform ongoing audits internally and as well as a comprehensive external audit annually.
Our auditing approach is recommended on-site to get the full view of your current situation. If you are investing in an outside consultant to evaluate your current compliance and reimbursement efforts why have them only look at a portion of the picture?
Here is what you can expect should you choose to use ACE for your annual review.
Step 1: Evaluation of Needs & Proposal Request
Contact the ACE office to gain additional information about our services and to evaluate the “fit” between your needs and our offering. We will collect information regarding your expectations, group size, and case volume. Click here to Contact the ACE office.
Step 2: Retain ACE
Once you have accepted our proposal a contract will be sent either directly to you or your legal counsel. We normally recommend that comprehensive compliance reviews be performed under ‘Attorney-Client Privilege’ if we are reviewing post-submission claims. It is the group’s choice whether to engage us through an attorney or independently.
Step 3: Pre-Audit Conference call with ACE Consultant
Prior to sending our audit preparation documents we like for a preliminary conference call to take place between our client and the assigned ACE Consultant. We want all of our clients to feel like they have a resource in ACE and can discuss the specifics of their situation prior to us showing up on-site the first day.
Step 4: Audit Preparation
We want you to receive the most value from ACE by utilizing our organizational tools to prepare for and understand the expectations of the audit. One month prior to your scheduled review you will receive 2 documents from the ACE office: 1) A questionnaire that will need to be returned to ACE 1 week before the audit and 2) A check list to be used by billing staff and medical records in preparation for the first day.
Step 5: On-site Review
Time on-site is spent reviewing records and educating key personnel. Education is the foundation of active compliance. At the end of every on-site review there are education sessions with providers, billing/coding staff, and administration to discuss findings and provide training. Annual education is a requirement for demonstrating active compliance. If you choose to utilize our operational review service additional interviews and documentation will occur on-site as well.
Step 6: Final Report
Within 15 days of the on-site review’s completion you (or your legal counsel) will receive a written educational report that includes audit findings, education, action items, and detailed spreadsheets.
Step 7: Your partner and resource
After the audit is done we don’t just disappear. For 6 months after your on-site review ACE is available to discuss your specific results as well as current issues within the specialty of anesthesia and pain management billing and compliance.