Healthcare Compliance | IRO Services

Providing expertise, integrity, and reliability for healthcare compliance challenges

The healthcare regulatory environment is complex and ever-evolving. Our experienced healthcare compliance professionals incorporate deep hands-on knowledge with industry best practices to help you ensure your operation is compliant and efficient.

Services

BerryDunn offers a comprehensive array of healthcare consulting solutions focused on helping organizations across the continuum of care meet their compliance obligations.

Independent Review Organization (IRO) services

Revenue integrity
services

HIPAA and HITECH compliance consulting

Healthcare compliance programs

Physician-led consulting services

Outsourced compliance and privacy

Independent Review Organization (IRO) services

BerryDunn offers in-house expertise, including certified medical coders and auditors, healthcare compliance professionals, and licensed nurses with wide-ranging experience across the continuum of care to competently conduct annual or quarterly claims reviews, to best meet the needs of any healthcare organization under a Corporate Integrity Agreement (CIA).

Claims reviews

Our team of certified medical coders, nurses, physician advisors, and compliance professionals consistently meet CIA Appendix A requirements for conducting professional and facility claims reviews.

Arrangements, systems, and transactions reviews

We bring deep expertise in Anti-Kickback Statues (AKS), Stark compliance, and physician compensation and valuation for thorough reviews.

Software reviews

We’ll help your team assess and review your software to ensure that your compliance obligations are met.

CIA compliance and implementation consulting

If BerryDunn is not the IRO, our team can advise on a variety of matters related to CIA compliance and implementation.

Revenue integrity services

Our revenue integrity services team includes seasoned mid-revenue cycle professionals, registered nurses, certified coders, and government and commercial payer policy compliance experts who help healthcare organizations take measures to avoid overpayments, while maximizing reimbursement for the great care they provide.

Coding compliance and clinical documentation audits

Our coding and documentation audits identify improperly coded claims, the impact to revenue of inaccurate coding, and appropriate medical record organization.

Coding and clinical documentation improvement training

Our experts are available to present coding education and training for staff and providers, in addition to advisory services around documentation and coding best practices.

Government and commercial payer audit response

Our experts collaborate with internal compliance resources or counsel to respond to government and commercial health plan audits.

HIPAA compliance consulting

Our team has deep HIPAA privacy and security, CURES, and HITECH compliance experience. We can lead, assist, and independently perform compliance risk assessments, HIM evaluations, penetration testing, security assessments, and policy analysis and development.

Healthcare compliance programs

BerryDunn’s compliance program effectiveness assessments are differentiated by our collaborative approach. Grounding our approach in best practices and the seven elements of an effective compliance program, our healthcare consultants work with organizational leadership to perform an independent assessment with actionable recommendations.

Physician-led consulting services

Our in-house physicians apply their medical expertise for IRO, claims review, revenue integrity services, and compliance consulting projects. In addition, our physicians provide clinical and operational perspective to multidisciplinary teams working with governmental and healthcare organizations.

Outsourced compliance and privacy

We offer outsourced Compliance Officer and Privacy Officer services, as well as tailored ad hoc compliance consultation to healthcare organizations launching compliance programs, enhancing their departments, or needing external expertise due to limited resources.