Compliance: Managing compliance in the age of health care accountability

An alphabet soup of program integrity initiatives: RAC, MAC, MIC, ZPIC, OIG, DOJ, HEAT

New financial incentives, payment models, and compliance mandates, coupled with a shifted national focus on reducing waste and fraud, presents today’s hospitals and physicians with growing compliance challenges in the new age of health care accountability. This era is full of a variety of Program Integrity Contractor initiatives and a veritable alphabet soup of acronyms. It is essential for hospitals to understand the roles of each group, how to deal with their findings and, when and how to appeal them. In addition, hospitals must have strong compliance programs in place to mitigate risk moving forward.

Meeting compliance requirements: it’s not enough to talk the talk

In order to demonstrate compliance, physicians and hospitals cannot simply state they are in compliance but must be able to demonstrate the validity and solidness of their internal compliance processes. Successful compliance programs are built on rigorous process, access to information, and proactive strategies. We offer a range of solutions that help you maintain compliance with HITECH and Meaningful Use, HIPAA 5010, ICD-10, and Medical Necessity Compliance.

Transparency, visibility, and consistency

Because all the elements of health care are interdependent, compliance requires transparency, visibility, and consistency. We provide the technology that delivers information in real-time, across all departments. Our services support consistent, reliable, and documented processes that help organizations demonstrate compliance. With a wide range of outsourced services, we can help organizations leverage outside experience and expertise to maximize productivity of internal resources.

A leader in compliance solutions

We offer a customizable, comprehensive compliance program from a single source. This suite of capabilities combines outsourced services, national expertise, and sophisticated technologies to meet the most complex compliance challenges. Executive Health Resources (EHR) is a market leader in medical necessity compliance, providing real-time medical necessity review and retrospective appeals management services to more than 1,300 hospitals in 49 states.

OptumInsight Provider Compliance solutions

• Assessment, Redesign, and Training
  • OptumInsight Consulting
  • Advisory Services – Executive Health Resources
• Medical Necessity Compliance
  • Acute Care, Inpatient/Observation, Medical Necessity Compliance and Appeals Management Solutions – EHR
  • Emergency Department, ICU, Operative Suite – Picis
  • Compliance Checking – CareMedic
  • Electronic Ordering for HIE – Axolotl Elysium Ordering
• Meaningful Use / HITECH
  • Ambulatory Practice Management and EHR – OptumInsight CareTracker™
  • Health Information Exchange for Hospitals – Axolotl Elysium Suite
  • High Acuity EHR – Picis CareSuite
• HIPAA / 5010
  • HIPAA 5010 Prepared
  • HIPAA Transaction Testing – Claredi® Classic
  • Ambulatory Practice Management – OptumInsight CareTracker PM
• ICD-10
  • ICD-10 Prepared
  • Enterprise Coding – OptumInsight Web.Strat
  • Computer-assisted Coding – A-Life Actus®
  • State Regulations – OptumInsight Easy Group
• Coding and Documentation
  • Outpatient Charge Capture
  • Audit Management – CareMedic
  • Computer-assisted Coding – A-Life Actus
  • Enterprise Coding – OptumInsight Web.Strat
  • RAC Compliance