Healthcare Compliance Services

The nation’s leading healthcare institutions trust the compliance professionals at VMG Health for all their compliance services.  At VMG Health, we have a proven track record of helping organizations like yours get healthcare compliant and stay compliant. Working with you, we’ll develop a tailored, measurable compliance program for your organization that will enable you to ensure you’re compliant. VMG Health understands that to be truly effective, your medical compliance program must:

  • Ensure that all individuals in your organization observe pertinent laws and regulations in the performance of their work.
  • Articulate a broader set of ethical standards that are well understood, and adhered to, within your organization.

When your healthcare entity requires a third-party perspective – either because you’re looking to reduce your administrative expenses or because you’ve been mandated to submit to an outside compliance review – VMG Health is there.

Our healthcare compliance services include:

Documentation Reviews

Our certified professionals review your documentation and medical coding services to ensure they’re appropriate and meet the requirements issued by CMS and other governmental regulations. We review it with an eye toward determining if the services provided are supported by the documentation present in the medical record. All services rendered are assessed for appropriate medical documentation requirements and code selection.

Medical Coding Audits

The purpose of this review is to help you identify areas of documentation improvement. We use a proprietary coding audit tool, similar to one approved by the Office of Inspector General, which assigns an accuracy rating to coding compliance issues identified. Medical record documentation, along with associated charge capture documents and/or billing forms are reviewed and compared to the codes billed or to be billed. Based on the issues identified, we provide appropriate recommendations, and corrective action plans to help you maintain healthcare compliance going forward.

Federally Qualified Health Center (FQHC)

VMG Health understands the complexities of FQHQs and ongoing changes. You can trust us to be current on our understanding of these entities and assist your organizations with:

  • Documentation and Coding Reviews
  • FQHC PPS Coverage, Billing and Reimbursement Support Services
  • Provider Education and Training
  • Specialties include: Behavioral Health, Child/Adolescent Health, Maternal Health, Adult Health, HIV/AIDS, Podiatry, Dentistry

Due Diligence Reviews

Our experienced coding and billing experts provide Due Diligence Support Services including random sampling, detailed audit analysis of medical record documentation and billing data and financial impact analysis. Our Due Diligence Services provide private equity firms and organizations with the support and analytical services needed to properly assess practices and groups for acquisition.

Educational and Training Services

To help ensure your practice remains in compliance, VMG Health conducts healthcare compliance education In-Services for providers and ancillary staff that address such topics as Medicare Teaching Setting Guidelines, Evaluation and Management Services (E&M) and documentation guidelines, appropriate documentation and healthcare coding compliance practices and non-physician practitioner guidelines. We also tailor our presentations to provide specialty-specific medical coding guidelines including NCCI edits and appropriate modifier use.

Corporate Compliance Program

We can develop and implement a medical compliance program to ensure your organization adheres to protocols and procedures related to HIPAA compliance, privacy rules, security policies, OMIG, OIG, appropriate medical record documentation, coding, billing, and claim processing guidelines. Our expert team will develop tailored policies, procedures, and manuals to support your organization’s compliance needs.

Investigations and Healthcare Compliance Advisory

Our experience in conducting investigations and our understanding of healthcare practice management and regulatory healthcare compliance provides our clients with valuable perspectives in support of defense and response strategies. Our services range from performing internal investigations to assisting clients in navigating the requirements of Corporate Integrity Agreements (CIA) to acting as the Independent Review Organization (IRO) mandated by a CIA and charged with an objective assessment of client operations.