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Compliance and Revenue Integrity Solutions

Our nationally recognized practice is prepared to help you face your sophisticated compliance needs. Our consultants have spent a great deal of time researching and analyzing governmental and third party guidelines and regulations. We have interacted with and have obtained credibility with the Central & Regional Offices of CMS, various U.S. Attorneys’ offices, the Office of Inspector General (”OIG“) for the Department of Health and Human Services and various Medicare Administrative Contractors (”MAC‘s“), and various Medicaid programs and their applicable enforcement agencies.

SunStone distinguishes itself in its Compliance and Revenue Integrity Solutions through; its commitment to remain with a client throughout all aspects of the engagement, the level of expertise brought to the engagement by its consultants and its philosophy of close collaboration with client staff which ensure an effective response to any identified risks. Our professional staff includes CPAs, RHIAs, CPCs, CPC-Hs, CCSs and RNs dedicated to your compliance needs. We offer a variety of highly advanced compliance solutions, tailored to each provider’s special requirements as follows:

Retrospective Compliance Solutions

Voluntary disclosures;
Assistance responding to government investigations;
Independent review organization functions for providers under a Corporate Integrity Agreement;
Criminal & civil litigation support;
Self-disclosure audits;
Level of care reviews;
Charge Description Mater and charge process assessment/management;
Cost report appeal and analysis;
Managed care contract audits;
Expert witness testimony;
Due diligence reviews.

Proactive Compliance Solutions

Corporate compliance program development;
Corporate compliance program effectiveness review;
Education related to compliance, documentation, coding and billing;
Review of inpatient and outpatient documentation and coding tendencies;
Ongoing inpatient and outpatient documentation, coding and billing reviews;
Ongoing compliance research and assistance;
Problem resolution including identification of barriers or root causes for aberrant audit findings;
Concurrent review programs;
Development of project work plan incorporating revisions to policies and procedures to ensure compliance with governmental regulations.

Recovery Audit Contractor (RAC) Solutions

With the RAC program in full swing, managing RAC requests and appeals has intensified resulting in increased administrative burden and labor costs for providers. SunStone has a full range of RAC Solutions to assist with the administrative burden related to the RAC environment including:

RAC Process Improvement Solutions
Cognizant of the robust administrative and operational demands that facilities face in responding to the RACs, SunStone will assess how a facility can best meet the demands based on already existing structures, processes and functional capacities.
RAC Appeals Management Solutions
SunStone’s Appeals team members have been involved with assisting clients with all areas identified by the RACs auditors. We have performed data mining, detailed claims and medical records analyses, quantified and extrapolated financial impacts, assisted clients and legal counsel on strategizing settlements, and assisted with corrective action for risk areas. Our staff is comprised of subject matter experts in any area that is or will likely be a focus of RAC review; DRG assignment, inpatient coding, medical necessity determinations and outpatient/inpatient billing.

For detailed information concerning SunStone Consulting Compliance Solutions please contact
Vonda Moon (vondamoon@sunstoneconsulting.com).

Charge Process (CDM)

Compliance

Documentation Accuracy Program

Outpatient Claim Analysis

Pharmacy Revenue Cycle

Pricing

Reimbursement & Financial Analysis

Revenue Integrity Solutions

Transfer MS-DRG Review

Workers’ Compensation Recovery

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