Monitoring and Compliance

StrategicHealthSolutions, LLC (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.

Services

  • Conduct analysis and research to identify patterns indicative of failure/success
  • Review compliance with Medicare rules, regulations, and manuals
  • Perform analysis to detect aberrancies
  • Perform medical management review
  • Evaluation of Quality Improvement programs
  • Detection of program vulnerabilities and need for Corrective Action Plans
  • Development and implementation of monitoring tools to validate compliance with regulations
  • Perform testing of Utilization Management criteria, validate Case Management decisions, and determine Disease Management impact
  • Perform testing of appeals and grievances
  • Identification of overpayments

The Strategic Advantage

  • Evaluation of Quality Improvement programs
  • Detection of program vulnerabilities and need for Corrective Action Plans
  • Development and implementation of monitoring tools to validate compliance with regulations
  • Perform testing of Utilization Management criteria, validate Case Management decisions, and determine Disease Management impact
  • Perform testing of appeals and grievances
  • Identification of overpayments