PFC Health Care Practice Audit

HEALTH CARE PRACTICE AUDITS

Provider Fraud Consultants, Inc. (PFC)

Daniel J. Osborne, M.S., Founder & President

18065 238th Street, Tonganoxie, KS 66086

¨ Audits Performed by an experienced practice auditor under direction / supervision of provider’s legal counsel — ensuring legal guidance available and protection from unwanted disclosures of audit findings is afforded

¨ Executed on-site, following checklist to right, while practice is open & seeing patients — allows for complete picture of practice activity to offer a comprehensive evaluation & thorough report

¨ Conducted to proactively detect time-bombs and violations of law — digging deep on behalf of provider as if we were a regulator, insurer &/or law enforcer looking for violations to prosecute; however, what we find is not used against provider but is used to empower provider

¨ Administered to deliver (via provider’s counsel) a confidential written report of findings with recommendations for corrective actions — resolve / mitigate existing administrative, civil &/or criminal exposure

¨ Completed to set (or enhance) the foundation for development (or administration) of an ‘effective’ compliance program — Empower Health Care Practices & Increase Practice Certainty

Background/Familiarization

· Clinic Appearance & Meet Personnel

· Business Structure, Organizational Control & Oversight

· Policies & Procedures

· Educational Resources & Training Programs

· Marketing / Advertising

· Employee & Vendor Agreements

· Licensure & Credentialing

· Key Employee Interviews

Health Care Services

· Patient Flow, Delivery & Delegation

· Patient Volume, Practice Percentages

· Review sampling patient files from each payer source

· Payor Agreements

· Offering Benefits

· Forms & Documentation

· Coding, Billing & Collections

· Records Retention & Security

Exposure Assessment

· Ancillary attacks

· Administrative Standards

· Medicare, Other Payor Requirements

· Criminal—State & Federal Statutes

Recommendations

· Professionals for further review

· Suggested remedial actions

· Date certain for compliance

Health Care Practice Audits, A Closer Look

PFC Affords HEALTH CARE PROFESSIONALS Audit Services to

Proactively Detect Practice Problems & Advance Compliance...

Þ Would your documentation and billings survive payor audits? We supply answers, as well as proven steps for responding to denials, post-payment audits and allegations of misconduct! Our years of experience assists on leveling the playing field. After all, just because they say it was wrong does not mean that it was, and, if wrong, we help correct the problems!

Þ What is your exposure level to allegations of administrative, civil &/or criminal misconduct? We are experts on identifying practice exposure and assisting providers on remediation, as well as on mitigating and/or eliminating any existing exposure!

Þ What would it cost to defend complaints before your regulatory board, civil lawsuits, and/or criminal charges? We assist on preventing practice activity that results in such actions. The costs of our services are a ‘drop-in-the-bucket’ of what would be spent to defend legal actions before regulatory boards and/or in civil & criminal courts!

Þ An attorney, writing in a chiropractic periodical, asks if audit-reports prepared for providers by compliance consultants (working both sides of the street) are made available to insurers and law enforcers? We can not speak on all consultants but in our case this just does not happen. We require all audit clients to retain legal counsel and only conduct our audits for provider clients under direction of the client’s attorney and make our prepared reports available only to the client’s attorney marked as ‘attorney-client privileged communication’. Further, we may work with providers, insurers, regulators and law enforcers at different times; however, such work never crosses over, and we do not ‘work both sides of the street’! We work only one-side—the right side, working with those committed in doing it right, the right way!

“Your evaluation showed us our strengths and areas to be strengthened. We have a renewed confidence in our procedures, documentation and compliance. We enjoyed getting to know you and appreciate the encouraging approach to compliance and quality care, and your being available for ongoing questions.” Brian Penwell, D.C. Read More

Don’t let your practice be like A HOUSE OF CARDS—pull a card out and it could ALL come tumbling down… Contact PFC for a Practice Checkup and ensure your Practice Foundation is Stable & Sound

Call 913-669-6987 or email cccpfc@gmail.com

for a ‘confidential’ Free Consultation

See Below for

‘A Closer Look’

Þ ALL PROVIDERS billing insurers are under investigation, key is what happens as a result. We assist providers in having a say in what happens — accurate & timely reimbursement, and staying away from activity that could result in referrals for further investigation!

Þ Are you confused on the health care laws & rules, and where to find correct answers? We show the answers, enhance understanding of the laws & rules, and use our diverse experience to bring different viewpoints & approaches to convey more detailed audit reports.

Þ Did you verify the accuracy of instructions from consultants & vendors before implementing? We assist on employing ‘trust-but-verify’ to confirm that instructions received are consistent with the laws & rules before they are put into effect!

Þ Are you practicing in fear of being a target of a fraud investigation, despite best efforts to do it right? We help remove the fear via guaranteed reliable answers, verifiable “sourced” information, and hands-on assistance to bank-on!

Þ Are you in a high-profile practice—multidiscipline, multiclinic group, significant PI or Medicare, extensive time-based services, etc? We specialize on working with high-profile practices and keeping them from becoming high-profile investigative and prosecutive targets!

Þ Law enforcers don’t have unlimited resources to investigate every provider and look for EASY targets. We ‘target-harden’ healthcare practices—assisting providers on staying out of the fraud target “danger-zone”!

EDUCATION & TRAINING PROGRAMS | PRACTICE AUDITS | COMPLIANCE PROGRAMS | INVESTIGATIVE ASSISTANCE

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