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Since the concept of compliance was first introduced by the
Office of the Inspector General (OIG), many in the
healthcare industry have come to view it an unfunded mandate
and administrative burden. At Sinaiko, our experience has
shown us that a solid commitment to enterprise - wide
compliance can actually improve an organization's fiscal and
operational performance as well as the quality of the care it
provides.
Regulatory and public scrutiny has made it even more critical
for healthcare organizations to demonstrate an unequivocal
commitment to maintaining a culture of compliance and ethics
that is fully embraced and supported by its governing body.
Sinaiko has deep experience in helping organizations develop,
implement and continually improve such a culture (and all the
details required to enhance services in this area), which can
also help mitigate any potential exposure to regulatory liability
and sanctions.
From compliance program development and due diligence
audits to coding education and claim reviews, our compliance
consulting services are performed by seasoned healthcare
professionals, including Certified Coders and Certified
Compliance Professionals, who have worked extensively in
all areas of the industry before joining Sinaiko. This experience
allows them a deep understanding of the industry, its
operational and fiscal complexities, and its regulatory
requirements. More importantly, it provides them with a unique
appreciation of the issues faced by our clients and the ability
to empathize with their challenges. As a result, our consultants
fully understand - and appreciate - the importance of
developing solutions that support a client's ability to "do the
right thing" and meet business objectives after the assignment
is complete. |
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Sinaiko's Compliance Services: |
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Developing and implementing corporate and departmental
compliance programs; |
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Collaborating with clients to craft compliance standards of conduct and policies & procedures that meet their unique needs and obligations; |
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Providing compliance
education to clinicians and non-clinician work
force members, along with focused training for
individuals involved in or responsible for revenue
cycle; |
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Assessing the effectiveness of mature compliance programs; |
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Designing and conducting audits of documentation, charge capture, coding and billing processes and systems; |
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Designing, implementing and monitoring programs and practices related to the oversight and management of sponsored clinical research, including reviewing clinical trial billing processes that have come under increasing scrutiny; |
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Initiating special audits for due diligence in joint ventures, mergers and acquisitions in the healthcare industry; |
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Serving as compliance officers and auditors on an outsourced basis; |
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Functioning as an Independent Review Organization (IRO) on behalf of organizations operating under a Corporate Integrity Agreement (CIA); |
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Providing expert assistance to organizations or individuals facing investigation and/or administrative or other sanctions and penalties by regulatory or law enforcement agencies; |
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Assisting “covered entities” review and monitor compliance with HIPAA rules and regulations. |
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Highly specialized areas include: |
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Lab coding and compliance |
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Academic medical center compliance |
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Integration of facility and professional fee coding/compliance in integrated environments |
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Investigations |
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Due diligence |
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For more information about Sinaiko’s compliance consulting services, please contact Dinh Nguyen at dinh.nguyen@sinaiko.com. |
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Following retrospective claims review, a publicly owned
and operated health services agency identified potentially
inappropriate billing practices for certain behavioral and
mental health services. After refunding overpayments
received in error from Federal healthcare programs, the
agency engaged Sinaiko Healthcare Consulting, Inc. to
serve as its independent third party review organization |
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FEBRUARY 2008
Auditing and Monitoring, Part 6: Bringing it all together with good management
By Jeff Sinaiko
Compliance Today |
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DECEMBER 2007
Auditing and Monitoring, Part 5: Be diligent with those "soft coding" requirements
By Jeff Sinaiko
Compliance Today |
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NOV - DEC 2007
Emerging Issues in Physician Documentation and Compliance: All of the Old, More of the New
By Jeff Sinaiko and Omid B. Toloui,
Journal of Health Care Compliance |
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