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Our Capabilities and Services 

 

Like most professionals, we have developed particular expertise in certain specialties. Below you'll find a list of services that cross specialty lines.

 

Please click for more information regarding the individual services Acevedo Consulting offers.

 

 

Appeals and ADRs

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CIA Support/IRO

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Coding and Chart Review

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Compliance

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Due Diligence

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Education and Lectures

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Expert Witness

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HIPAA

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Medicare and Medicaid Credentialing

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Policies & Procedures

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Specialty Expertise

 

 

 

 

 

Appeals and ADRs

 

 

With the increasing number of payer audits and the backlog of appeals facing Second Level Administrators and Administrative Law Judges, it is more fundamental than ever that your initial response to an audit is pristine.

 

From the initial submission in response to an ADR or audit request to any necessary appeals, Acevedo Consulting can assist you and/or your attorney throughout this entire process. Our goal is to mitigate the organization's risk by identifying the cause of the review and creating a strong appeal. Our diligent analysis of your medical records will seek to include the following information for use in your response to the payer:

 

• Supporting documentation of all services billed;

• Documentation to support the medical necessity of services according to payer coverage guidelines;

• The accuracy of the codes billed; and that

• The payer's technical requirements have been met.

 

Following our review, we can provide a report of findings which can serve as an independent expert cover letter for your submission.

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CIA Support/IRO

 

 

Entities and healthcare providers who find themselves under a Corporate Integrity Agreement (CIA) are aware that there are a number of terms and obligations that must be complied with. A common component of CIAs is the requirement to engage an Independent Review Organization (IRO) to conduct claims and/or arrangements reviews. Having served as the IRO for several organizations, ACI understands the importance of these responsibilities.  In addition to compliance expertise, ACI can also provide clinical expertise to comply with the CIA terms that require a clinical review of medical necessity. ACI's IRO proficiencies include claims, arrangement and medical necessity reviews.

 

Our experience as an IRO provides our clients with the expertise necessary to manage IRO engagements effectively and efficiently by working in tandem with the OIG, legal counsel and the entity or individual.

 

If the CIA requires engagement of a compliance expert, we are uniquely qualified to fill that role. Even when this is not a required element of the CIA, engaging us to support your implementation efforts, provide "mock" IRO audits, and just overall support is another area clients have found our work of great value.

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Coding and Chart Review 

 

 

As CPT, HCPCS and ICD codes change, or as your organization adds more services, let us guide you towards complete and accurate coding. Our credentialed staff can help ensure you are aware of the documentation requirements and get you on your way to correct coding for proper reimbursement.

 

Whether you have a formal compliance program or not, one of the only ways to know if your documentation and coding meet the payers' guidelines is to have an independent, objective chart review.

 

Depending on your needs and the focus of the review, there are varying approaches that Acevedo Consulting takes. Our review process is quite comprehensive. Utilizing the risk areas outlined in the OIG's guidances, we not only check that the documentation supports the services billed. If the information is provided to us, additional areas reviewed may include the appropriate use of modifiers, medical necessity of the service, diagnosis coding, incident-to services and any inappropriate unbundling.

 

The services provided by Acevedo Consulting are performed in accordance with applicable professional standards. All chart audits are performed by a Certified Professional Coder (CPC).

 

Reviews can be performed:

 

• Prospective or retrospective

• Onsite or remote via EHR access or record upload to our secure client portal

• In conjunction with your health care attorney

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Commonly requested reviews include:

 

• Due Diligence

• Baseline Review

• Focused Follow-up

• Annual "Check Up"

• MRA/HCC "Mock" Rad-V

• New Provider

• Hospice Level-of-Care

 

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Compliance

 

 

Under the Affordable Care Act, compliance programs are mandatory for all health care providers and third-party billing companies  who accept any federal health care payments (Medicare, Medicaid, Tricare, etc.). Furthermore, the OIG believes that every compliance program should begin with a commitment to address the seven elements of an "effective" compliance program. Based on the seven elements set forth in the Federal Sentencing Guidelines, defined as:

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1. Establishing compliance standards through the development of a code of conduct and written policies and procedures.

2. Assigning compliance monitoring efforts to a designated compliance officer or contact who reports to the governing authority.

3. Conducting comprehensive training and education on practice ethics and policies and procedures.

4. Conducting internal monitoring and auditing, focusing on high-risk billing and coding issues through performance of periodic audits and risk assessments.

5. Developing accessible lines of communication, such as discussions at staff meetings regarding fraudulent or erroneous conduct issues and community bulletin boards, to keep practice employees updated regarding compliance activities.

6. Enforcing disciplinary standards by making clear and ensuring employees are aware that compliance is treated seriously and that violations will be dealt with consistently and uniformly.

7. Responding appropriately to detected violations through the investigation of allegations and the disclosure of incidents to appropriate Government entities when appropriate.

 

Acevedo Consulting can:

 

• Develop your Code of Conduct and Compliance Plan, using a risk assessment approach

• Conduct your "kick off" and annual compliance training

• Provide ongoing support for your compliance staff

• Conduct chart reviews as part of your ongoing auditing and monitoring

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Due Diligence

 

 

Whether you are purchasing or investing in an organization, or you are an organization bringing on a new provider, due diligence reviews should be an essential component of the process. At a time when one's billing habits can have severe financial repercussions on future reimbursement and potential  penalties, it is important to identify reimbursement and compliance risks and/or opportunities during the vetting process, including evaluating RVUs or other areas that may play a role in provider compensation. Our approach can validate the RVUs for your fair market valuation, and provide guidance on how to incorporate the impact on CMS's Quality Payment Program. To avoid being blindsided, ACI's clients count on the team to evaluate the provider's current reimbursement and compliance trends so that they have a better understanding of the current state of affairs from the start.

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Education and Lectures

 

 

Nationally known for our ability to make complicated subjects understandable, Acevedo Consulting provides personalized education, individualized to meet the needs of your organization.

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Whether you need a refresher, education for a new provider or want to know about new payable services, our team has the knowledge and expertise most organizations cannot afford to have in-house.

 

• Physicians

• Non-Physician Practitioners (NPPs)

• Therapists

• Hospices and Palliative Care Programs

• Ancillary Staff

• Executive Management

• Train-the-Trainer Program

• Medical Specialties

 

Some of our most requested topics include:

 

• Evaluation and Management Services

• ICD-10-CM Specialty Training

• Modifiers

• MRA/HCC Coding

• Local Coverage Determinations (LCDs) & Medical Necessity

• Documentation/Reimbursement

• Quality Payment Programs (QPP)

• Incident-To Billing

• HIPAA

• Compliance

• Fraud and Abuse Training

• Hospice and Palliative Care Physician/NPP Services

 

Acevedo Consulting can provide education either on-site or via interactive webinar.

 

When a less personalized session will do, check out our events page.

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Expert Witness

 

 

 Often times, compliance with medical record documentation, coding principles or Medicare and/or Medicaid coverage policies are a focus of investigations, lawsuits and whistleblower allegations. 

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Having served as an investigative consultant for the Department of Justice and expert witness for nationally recognized law firms in dozens of cases, Acevedo Consulting has the needed expertise to evaluate each case with an unbiased and rational approach. Whether it be for the plaintiff or the defense, our team understands the importance of expert testimony. We take each engagement seriously and take the time to understand the nuances of each case so that our approach and team members' opinions are easily validated by authoritative resources.

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HIPAA

 

 

Every Covered Entity and their Business Associates must implement processes, procedures and education and training to help ensure HIPAA compliance.

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Often referred to as the 800 lb. gorilla in the room, HIPAA is often the one concept that everyone knows, but the first to be overlooked. With the potential for steep fines assessed for the breach of protected health information, HIPAA compliance should be at the forefront of every organization's compliance goals.

 

 Acevedo Consulting's HIPAA program is designed to incorporate HIPAA Privacy and Security. Where applicable, state privacy regulations may also be incorporated. Our Privacy and Security HIPAA Program consists of the following components: 

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• An Assessment comprised of a "minimum necessary" self-assessment tool used to assist in documenting the "need to know" requirement of the Rule.

• A walk-through of the organization completed by a member of the Compliance Team, to assess possible risk areas not evident to the eye of an everyday employee.

• Working with the applicable entities to document the required Security Risk Analysis for the components identified on the Security Standards Matrix of the Security Rule.

• Based upon the data collected from the assessments and interactive feedback from the client, Acevedo Consulting develops HIPAA Privacy & Security policies and procedures including any relevant forms.

• Acevedo Consulting works with the organization to determine the best method to conduct policy and procedure training to all members of the workforce.

 

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Medicare and Medicaid Credentialing

 

 

Rather than wondering if you have correctly completed the necessary paperwork, let our experienced staff handle your Medicare and Medicaid credentialing. We'll make sure you submit the right information and we follow the process through, saving you time and aggravation.

 

 

Allowing Acevedo Consulting's team to assist you with completing and submitting Medicare and Medicaid enrollment applications will ease the inevitable pressures of this process.

 

• Medicare:

  • Individual Providers (e.g., Physicians/NPPs)

  • Group Practices

  • IDTFs/Mobile Imaging

  • DME Suppliers

  • Clinical Laboratories

• Medicaid:

  • Individual Providers (e.g., Physicians/NPPs)​

  • Group Practices

 

 

For Florida, Acevedo Consulting provides guidance on the required information for the Health Care Clinic License as it is gathered, completed and submitted to the Agency for Health Care Administration.  We also assist in any follow up requests from the Agency of Health Care Administration needed to facilitate issuance of the license, and can conduct a mock survey to help ensure compliance when the surveyor arrives.

 

• Health Care Clinic Licenses

• Health Care Clinic Establishment Permit

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Policies and Procedures

 

• Corporate Compliance

• HIPAA

• Nondiscrimination Notice Requirements (Section 1557)

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Specialty Expertise 

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Our team is nationally respected as the premier consultants in a number of areas. Please click on one of the following links for further information:

 

• Diagnostics and Imaging

• Hospice and Palliative Care

• Medical Specialties

• Quality Payment Programs

• Therapy Services 

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Diagnostics and Imaging

Acevedo Consulting appreciates that optimizing diagnostic billing requires an understanding of the regulatory requirements not only of billing, but Medicare credentialing of both physicians and staff. Capturing accurate CPT codes, documenting physician orders, modifiers, correct place of service and dates of service are critical for proper reimbursement. More than any other healthcare provider, being paid for your services is dependent on someone else: the ordering physician.

It’s clear that the Medicare program is paying more attention to signed, documented physician orders when reviewing claims for diagnostic services. And, as all government budgets tighten, it should not be surprising that the Medicare program will continue to look for potential over-payments through the audit process. Acevedo Consulting was deeply involved with the Recovery Audit Contractor’s audits during the 3-year Florida demonstration program.  Allow our experiences and expertise to aid you in preparing for the inevitable audit.

Whether a mobile diagnostic company, teleradiology group or an IDTF, we can assist you with developing and implementing a compliance program that meets your needs and conducting chart reviews.  Acevedo Consulting also has experience serving as the Independent Review Organization (IRO) for radiology groups and ITDFs under Corporate Integrity Agreements (CIA), and provides needed consultative support and expertise throughout the term of a CIA.   Our understanding of and particular expertise in the industry’s nuances is paramount to balancing risk and practicality while optimizing revenue.

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On-site education programs are built specifically for each client's needs. Both lecture and hands-on application techniques will be utilized. Please contact us for more information.

 

 

 

Hospice and Palliative Care

 

Our consultants are respected as the premiere compliance experts in Hospice and Palliative Care physician services.

 

We are honored to be the only consultants with this expertise to be able to include both the National Hospice and Palliative Care Organization (NHPCO) and the American Academy of Hospice and Palliative Medicine (AAHPM) as clients of the firm.

While most hospices have fairly robust compliance programs, quite typically a focus on physician billing is missing. We help to ensure that an organization can incorporate compliance functions for physician billing while optimizing the revenue stream.

Acevedo Consulting appreciates that optimizing physician billing requires an understanding of the regulatory requirements of the levels of care under the Medicare Hospice and Fee-for-Service Benefits. CPT codes and modifiers vary based on the location of service as well as the physician’s role with respect to the patient and the hospice/palliative care organization.  And, as the use of nurse practitioners expands, consideration must be given as to how best to incorporate these practitioners into the program and still be compliant with the regulations. Our expertise can assist you in reviewing the various relationships and the appropriate approach to billing for each.
 
Our physician and non-physician practitioner reviews and education have proven invaluable as the nuances of the specialty bring particular challenges. We also conduct hospice-specific reviews, particularly as this relates to long length of stay and the levels of care. This service can be provided as a team approach: a hospice coding expert working with one of our hospice physician consultants. This approach brings together the critical components of the technical requirements and the medical necessity aspects of billing for hospice services. Acevedo Consulting can help ensure third-party payers are not successful in retrospective recoupment and that your hospice or palliative care program is able to optimize the revenue potential of physician services with services such as Advance Care Planning.

 

It’s clear that the Medicare program is paying more attention to services billed by hospice and palliative care providers through increased use of ADRs. CMS' goal is to reduce/prevent improper payments. And, as all government budgets tighten, it should not be surprising that the Medicare program will continue to look for potential overpayments through the audit process. Allow our experiences and expertise to aid you in preparing for the inevitable audit.

Acevedo Consulting also has experience serving as the Independent Review Organization (IRO) for hospice and palliative care organizations under Corporate Integrity Agreements (CIA), and provides needed consultative support and expertise throughout the term of a CIA. 

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On-site education programs are built specifically for each client's needs. Both lecture and hands-on application techniques will be utilized. Please contact us for more information.

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Medical Specialties

 

Our client list includes the following Medical Specialty areas:

 

• Anesthesiology

• Cardiology

• Endocrinology

• Family Practice

• Gastroenterology

• Hospitalists/Internal Medicine

• Interventional Pain Management

• Nephrology

• Neurology

• Oncology/Hematology

• Orthopedics

• Otolaryngology

• Pediatrics

• Physiatry

• Pulmonology

• Rheumatology

 

While many practices have compliance programs - at least in spirit - these are now mandatory for all Medicare and Medicaid providers, regardless of specialty. Acevedo Consulting has years of experience developing and implementing compliance programs tailored to physician practices, clinical laboratories and third-party billing companies.

 

It is clear that the Medicare program is paying more attention to services billed through increased use of ADRs. CMS' goal is to reduce/prevent improper payments. And, as all government budgets tighten, it should not be surprising that the Medicare program will continue to look for potential overpayments through the audit process. Acevedo Consulting was deeply  involved with the Recovery Audit Contractor's audits during the three year Florida demonstration program. Allow our experience and expertise to aid you in preparing for the inevitable audit.

 

On-site education programs are built specifically for each client's needs. Both lecture and hands-on application techniques will be utilized. Please contact us for more information.

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Quality Payment Programs 

 

 

The historical Medicare Part B fee schedule payment method has not contained incentives for physicians and non-physician practitioners to focus on the quality of care, the relative value of each service they furnish, nor the cumulative costs of services or items they provide and order, and the services that their patients receive from other providers. CMS' Quality Payment Program (QPP) goals are to improve quality and lower the per-capita growth in expenditures - an important component in revamping how care and services are paid for. CMS aims to drive improvement in our national health care system through the use of quality measures and periodic assessment of the impact of such measurement. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) established payment incentives for physicians and other clinicians based on quality, rather than quantity, of care. These changes are also being implemented by major commercial health insurers and HMOs, impacting relationships with other providers, ACOs and hospitals.

 

Whether it be providing education "on the basics" or helping to evaluate the current state by reviewing reports and benchmarks, the ACI team can help. Assistance can include identifying quality measures, recommending reporting options and developing an implementation plan. Since ICD-10-CM codes are being used to risk adjust beneficiaries by Medicare for projected costs, ACI can also evaluate the organization's current use and understanding of diagnosis coding and educate providers and other staff on the importance of proper diagnosis coding.

 

On-site education programs are built specifically for each client's needs. Both lecture and hands-on application techniques will be utilized. Please contact us for more information.

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Therapy Services

 

Acevedo Consulting appreciates that optimizing therapy billing requires an understanding of the regulatory requirements not only of billing, but Medicare credentialing of therapists, physicians and staff. Capturing accurate CPT codes, modifiers, functional impairment and dates of service are critical for proper reimbursement.  Changes to the evaluation codes have also added a degree of complexity therapists have not had to previously consider.

Since the mid-2000s Medicare credentialing and documentation requirements have undergone dramatic changes. And, for therapists, it has never been clearer how important it is to properly document the medical necessity for services in the initial Evaluation/Plan of Treatment as well as in the Clinician's Progress Report. Beginning in 2009, Medicare began a renewed emphasis on signed physician orders, and what constitutes a "legible signature". Therapists must have solid protocols in place to meet all documentation requirements to be able to successfully respond to a Medicare records request.
 

It is clear that the Medicare program is paying more attention to signed, documented physician orders when reviewing claims for physical and occupational therapy services. And, as all government budgets tighten, it should not be surprising that the Medicare program will continue to look for potential overpayments through the audit process. Acevedo Consulting was deeply involved with the Recovery Audit Contractor’s audits during the 3-year Florida demonstration program.  Allow our experiences and expertise to aid you in preparing for the inevitable audit.

Whether in private practice or providing therapy services in a physician practice, Acevedo Consulting can help ensure providers meet the Medicare definition of "covered services" and that documentation meets payer criteria. Our understanding of and particular expertise in the industry’s nuances is paramount to balancing risk and practicality while optimizing revenue.

 

On-site education programs are built specifically for each client's needs. Both lecture and hands-on application techniques will be utilized. Please contact us for more information.