Compliance
Are You Keeping Up?

Complicated billing regulations, confusing coding rules, complex Medicare policies, fear-driven down coding. Any one of these may result in lost reimbursement, and affect your bottom line. Worse yet, you could be at risk for governmental fraud investigations.

The time to take preventative action and protect your interests is now. By utilizing the full array of Compliance Services provided by Nicka & Associates, you will be able to optimize financial performance while simultaneously reducing vulnerability to allegations of fraud or abuse. Allow the professionals at Nicka & Associates to assist you in the implementation of effective controls that promote adherence to federal and state laws.

Step One - The Baseline Audit
Nicka & Associates recommends a baseline audit performed by an organization which specializes in compliance audits for the specialty of emergency medicine, urgent care and hospitalists services.  At Nicka & Associates, we not only specialize in emergency medicine, but offer a tradition of experience which spans over thirty years in the emergency medicine arena. Drawing upon our experience, our external audit provides an objective approach to determining whether problems exist and provides a framework for developing a remedy for concerns.

Step Two - The Comprehensive Compliance Plan
In addition to the compliance audit and report, Nicka & Associates will ensure your coding conforms to, and is on target with best practices. We will do this by creating and implementing a comprehensive compliance plan that is tailored to meet the individual needs of your company. As part of this plan, we will provide ongoing regulatory updates and recommend quarterly audits in order to achieve optimal risk management.

Arranging for Your Baseline Audit
The process of a compliance audit is simple and easy to arrange. The client forwards copies of the ED, Urgent Care, or Hospitalists records along with the codes assigned to each chart. Nicka & Associates' auditor will utilize the CMS Documentation Guidelines or CPT Principle to determine the correct evaluation and management level, CPT procedure codes and modifiers for each chart. The assignment of evaluation and management level is based on the physician's documentation of history, physical and medical decision making.

Once our evaluation is complete, a detailed report and assessment will be submitted to the client. The report will include the following information:

	The error and accuracy rates for E/M level coding, summary of findings with proposed recommendations and action items
	A chart by chart detail to provide comparative analysis of the original coding, Nicka & Associates coding and rationale for any differences in code assignments.