Peak's Compliance Services:

Healthcare organizations are struggling daily with increased government investigation, increased legislation and public profiling causing an ever-increasing need to ensure accurate documentation and coding practices. Peak Health Solutions, Inc.’s Compliance Audit staff assists our clients in minimizing risk and regulatory exposure. We utilize the knowledge we have gained through education and our experience in conducting compliance reviews for healthcare providers nationwide and transfer that knowledge and insight to ensure that the coding and documentation practices of our clients are in compliance with Medicare and Medicaid regulations. Our team of experienced compliance auditors reviews the entire medical record to identify insufficient documentation and coding practices and provide you with the recommendations and tools to implement performance improvement and education plans.

Peak Health Solutions, Inc.’s Coding Compliance Audits benefit healthcare facilities by:

• Validating the quality of coding functions.
• Identifying opportunities for improved physician documentation.
• Providing validation that payer reimbursement is based upon correct coding principles.
• Reaffirming the commitment to quality and organizational excellence.

Revenue Audits

Revenue audits focus on lost or incorrect reimbursement and can be completed through concurrent pre-bill reviews or retrospective reviews. Concurrent pre-bill audits focus on identifying coding errors prior to the bill being submitted to the payer, allowing you to eliminate any potential revenue loss or compliance liability. Retrospective revenue audits are conducted on a monthly, quarterly, or annual basis to identify inaccurate reimbursement due to coding errors and insufficient documentation. At the conclusion of the audit, a detailed report of quantifiable findings and recommendations is provided, including specific educational opportunities that can be used to develop education and training plans for your physicians and coding staff. Our Revenue Audits provide a thorough evaluation of your company’s internal processes and can help you reach your compliance goals and ultimately improve reimbursement.

Peak Health Solutions, Inc.’s Customized Revenue Audit Services include:

• Concurrent pre-bill audits to ensure accurate reimbursement prior to bill submission.
• Pre-bill audits that are conducted with no negative impact on DNFC.
• Retrospective audits that can be performed monthly, quarterly or annually.
• Detailed reports for development of performance improvement plans.

Peak Health Solutions, Inc.’s Revenue Audits benefit healthcare facilities by:

• Minimizing regulatory risk.
• Identifying missed or lost revenue.
• Ensuring a more accurate Case Mix Index (CMI).
• Decreasing exposure to external audits and preparing for RAC and other government reviews.
• Identifying vulnerable areas and fraudulent practices.
• Recovering missing revenue.