The key to anticipating and managing risk is having experienced leadership, who can guide organizations through volatile and highly regulated business environments.
Granite GRC’s experienced organizational and risk management consultants bring the insights and skills needed to predict, mitigate and manage risks with agility and ease. Our consultants find creative ways to turn risks into opportunities for organizational improvement, revenue enhancement, and competitive advantage.
Granite GRC’s skilled consultants engage with MA plans and provider groups to analyze their claims data, review risk adjustment focused processes and audit medical documentation to identify gaps and address opportunities for improvement in the accuracy and completeness of clinical data.
Our experiences drive our risk adjustment programs and training for our clients, using proven strategies, solutions and analytics for Medicare, Medicaid and commercial payers, accountable care organizations (ACO), and others participating in risk adjustment-based programs. Our goal is to improve reimbursement, patient care, and patient experiences.
We are able to assist clients through the following services:
- Apply advanced analytics to benchmark data and results
- Target observed weaknesses and trends to customize strategic pathways to success
- Apply experience and best practices to develop policies and protocols that drive patient and provider clinical engagement and results
- Fine-tune provider documentation and abstraction of codes from the medical record to improve medical coding and HCC recapture
- Address compliance requirements through focused solutions centered around accurate diagnosis reporting
- Investigate opportunities for improvement and make recommendations for risk adjustment focused processes
- Prepare for CMS and HHS RADV audits
- Support responses to outside inquiries and legal actions
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
We assist organizations through all the phases of pre-litigation and litigation. Our consultants help you to understand and navigate litigation while easing the impact of legal proceedings, allowing organizations to better focus on their primary purposes – serving customers and driving business growth.
We provide the following services:
- Systems and transactions assessments and analyses
- Consultation, support and performance of internal investigations
- Forensic evidence collection and analysis
- Assistance with interrogatories, document requests and document reviews
- Support for depositions and other interviews
- E-discovery and data mining
- Trial exhibits and courtroom presentations
- Expert witness testimony
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