Governance

Our consultants have decades of experience helping a wide range of medical providers improve their revenue cycle processes. They help clients effectively identify and assess payment and reimbursement challenges, achieving full, appropriate payment for services with adequate documentation of conditions, diagnoses and services across an array of varying payment systems and requirements, including inpatient, outpatient, dental, ASC, FQHCs, PACE, home health, and hospice.

• Payor contracting, including FFS, PPS, risk adjustment, capitation, bundled payments, value-based, shared savings and other payment models
• Healthcare revenue cycle management, from credentialing through appeal of denials
• Concierge and cash medicine models
• Documentation, coding and billing reviews and analyses
• Medicare Incentive Payment System analyses and improvement
• Charge capture analysis and credit balance reviews
• Denials management and appeal
• Credit balance reviews
• UPIC review analyses and responses
• Voluntary and mandatory self-reporting

From inpatient and outpatient services through telehealth, we comprehensively address revenue matters involving office, outpatient and inpatient services, including TMS services, partial hospitalization programs, intensive outpatient programs, community mental health centers, behavioral health integration services, inpatient and outpatient drug and alcohol treatment and detoxification, rehabilitative services, medication assisted treatment, and other areas. No revenue cycle operation is perfect, but with our trusted consulting, your organization can improve its payment and reimbursement processes and results, leading to better business performance.

We provide the following services:

• Payor contracting, including FFS, PPS, risk adjustment, capitation, bundled payments, value-based, shared savings and other payment models
• Health care revenue cycle management, from credentialing through appeal of denials
• Coding and billing documentation review and analyses
• Medicare Incentive Payment System (MIPS) analyses and improvement
• Concierge and cash medicine models
• Charge capture analysis and credit balance reviews
• Denials management and appeal
• Credit balance reviews
• UPIC review analyses and responses
• Voluntary and mandatory self-reporting

Our consultants work directly with leadership to create executive oversight that enables insightful decision making and sound organizational performance.

We provide the following services:

• Board and executive coaching and mentoring
• Governance best practices, policies and processes
• Enterprise risk management strategies and execution
• Compliance, privacy, and information management structures and programs
• Communication strategies and programs
• Auditing and monitoring strategies and programs
• Interim and consulting risk, compliance, information privacy and cyber security officers

We help organizations identify actionable information, insights and recommendations that support appropriate corrective and preventive actions.

We provide the following services:

• Systems and transactions assessments and analyses
• Performance of (and consultation and support for) internal investigations
• Forensic evidence collection and analysis
• Third party risk evaluation and management
• Credible, risk-appropriate resolutions, including corrective and preventive actions
• Advice and support for matters involving mandatory and voluntary self-reporting
• Guidance and assistance with interactions with government and other officials
• Crisis response and communications

Our experienced professionals guide and support organizations as they respond to a range of audits and inquiries. We help by assessing claims and collaborating with executive boards, leadership teams and legal counsel to craft and support effective and appropriate responses.

We provide the following services:

• Systems and transactions assessments and analyses
• Consultation, support and performance of internal investigations
• Forensic evidence collection and analysis
• Third party risk evaluation and management
• Credible, risk-appropriate resolutions, including corrective and preventive actions
• Advice and support for matters involving strategic responses
• Assistance with mandatory and voluntary self-reporting
• Guidance and assistance with interactions with government and other officials
• Crisis response and communications

Complex governance, risk and compliance-related matters require professionals with high levels of expertise and experience to effectively understand, apply and explain. Our consultants assist clients and their legal counsel to prepare cases and thorough testimony for decades.

Our services include developing litigation strategies, providing effective written reports, testimony in depositions, arbitrations and in court, as well as assisting in representation before government agencies.

Spanning the breadth of corporate governance, risk and compliance, our service areas include:

• Revenue cycle integrity, including claims analysis, coding, documentation and billing
• Financial transactions and relationships, including matters involving kickbacks, corruption, conflicts of interest and self-referrals
• Business transactions, including disputes in mergers and acquisitions
• Information privacy, including matters involving breaches of HIPAA, HITECH, and related U.S. Federal and state laws, regulations, and best practices
• Information security, including cyber security, such as information loss due to ransomware, spyware, fileless malware, adware, trojans, worms, viruses, keyloggers and bots
• Internal analyses and investigations, including protocols, processes and results
• Responsible corporate officers, including board and management responsibilities and liabilities
• Corporate integrity and compliance, including duties of loyalty and care, and related processes and controls

Skilled medical record documentation is central to almost every aspect of patient care, payment and liability management. Strong documentation is even more important when under the scrutiny of our legal system.

Experienced Granite GRC consultants collaborate with health care providers across the spectrum to examine, assess, improve, and defend their medical record documentation.

Our professionals help health care providers with the following services:

• Produce consistent, accurate, specific, detailed medical documentation, effecting enhanced and efficient patient care
• Achieve a high order of specific, accurate, and detailed medical documentation to help to ensure the most precise payor coding, resulting in optimal and appropriate payment for their services, and reduced payment denials
  
• Improve revenue cycle efficiency and effectiveness, reducing revenue leakage and improving policies, processes, workflows and results
• Provide medical records with reduced ambiguity, inconsistency, or clinical incompleteness to reduce risks associated with legal matters and/or external reviews
  
• Defend the clinical appropriateness of documented services before a variety of tribunals, including federal and state agencies and boards, in arbitration proceedings and in the courts