StrategicHealthSolutions, LLC (Strategic) understands that protecting and preserving our health care dollars requires a multifaceted approach. Strategic provides Federal health care agencies a range of services that support education, oversight, and enforcement of the health care programs. Use the links below to read more about our comprehensive services.
Strategic provides medical review that supports several services, including Medical Management policy review, compliance with benefit and coverage regulations, billing and overpayment calculation, fraud case support, expert testimony, appeals and grievance support, and coding validation. Decisions are based on defined criteria, which are supported by regulation and meet high standards of quality.
Our team’s knowledge, skills, and experience ensure our ability to conduct a thorough analysis of medical record documentation. This expertise also is used to validate that medical services are rendered consistent with Medicare and/or Medicaid coverage guidelines and are medically reasonable and necessary.
Strategic develops, designs, and delivers educational materials, including brochures, pamphlets, fact sheets, PowerPoint® presentations, web-based training, and reference guides to a wide range of audiences such as beneficiaries and providers. Experienced editors, curriculum writers, Subject Matter Experts (SMEs), trainers, graphic artists, and Web developers work collaboratively to create topic-specific educational tools using a variety of plain language materials available in print, Web, and mobile formats.
Business and technology professionals at Strategic examine and determine a program’s specifications and objectives from multiple perspectives to formulate and execute a plan for comprehensive support services focused on optimizing business operations. We provide transition management, risk management, security oversight, and communication services throughout the program’s life cycle to ensure the program runs smoothly.
As an integration contractor, Strategic monitors all program components to ensure they function efficiently and in conjunction with the intention of the overarching program. As part of that process, we ensure any new or ongoing activity within the program is properly communicated, handled, and managed by all related business units and supporting stakeholders. Having an understanding of each component of the program allows us to investigate possible areas of waste and pinpoint opportunities for program improvements, resulting in a positive return on investment.
Strategic provides research and analysis of healthcare programs, statutes, regulations and guidance, and potential program vulnerabilities to combat program inefficiencies and fraud, waste, and abuse. Strategic delivers data-driven decision analysis paired with subject matter expertise resulting in actionable outcomes and revealing previously unknown opportunities on a range of topics related to Federal and State healthcare programs.
Strategic provides compliance and regulatory monitoring audits. Areas of focus include medical management oversight, detection of aberrancies through data analysis, overpayment identification, and detection of program vulnerabilities. Audit tools are tailored to each audit type and include methods to determine compliance with organizational policies and procedures and regulatory requirements.
Strategic provides enrollment and eligibility services for a variety of government programs. Enrollment application screening is performed to verify compliance with enrollment standards, determine whether the information is sufficient, and process initial enrollments as well as change of information applications. All application screenings are performed according to the instructions of the Medicare Program Integrity Manual.
Strategic has solid experience in analyzing Medicare beneficiary enrollment and eligibility information and has the ability to manage high-volume review workloads in keeping with mandated time frames.
