Healthcare Compliance, Investigations, and Certification

INVESTIGATIONS & CONSULTING

AUDITS

REVOCATIONS

ADMINISTRATIVE ACTIONS

POST-PAYMENT & PRE-PAYMENT REVIEWS

OVERPAYMENTS & PAYMENT SUSPENSIONS

Services Provided

INVESTIGATIONS & CONSULTING

We provide investigation and consulting services to thoroughly examine your practice’s medical billing procedures and develop a plan of action to correct deficiencies, ensure compliance with appropriate and relevant rules, and improve claim payments.

AUDITS

We provide thorough auditing services to examine your practice’s strengths and weaknesses and to determine potential causes for post-payment and pre-payment reviews as well as overpayments and payment suspensions.

REVOCATIONS

When Medicare revokes a provider’s billing privileges, the provider is no longer able to participate in a federally supported healthcare program. Most commonly, abuse of billing privileges results in revocation. We assist by using our expertise in the regulation and enforcement of the revocations to help formulate a plan of action to appeal to reinstate privileges.

ADMINISTRATIVE ACTIONS

We provide guidance as to the handling of medical claims that have not yet been paid that are under review, as well as claims that have been paid and are under investigation. We assist our clients in their response to providing supporting information that will be reviewed by the auditors, and develop a strategy to streamline claims and payments. Additionally, we assist in responding to a pre-payment review in order to have the action removed or altered to a sustainable level by the medical provider to avoid devastating the practice.

POST-PAYMENT & PRE-PAYMENT REVIEWS

OVERPAYMENTS & PAYMENT SUSPENSIONS

We assist our clients in responding to claims of overpayment for medical claims for services previously rendered, as well as reducing overpayments already demanded. We assist with the interpretation of demand letters and the appeal process. We provide critical guidance and expertise in the handling of suspension of payment for medical claims for services previously rendered. Said claims could be flagged for fraud or overpayment, which can devastate a provider. We assist by conducting internal audits to prevent future suspensions from occurring, as well as the negotiation of reducing or removing these suspensions, which could result in the medical practice closing. We offer internal auditing services to prevent future overpayment and suspensions.

Be Prepared.

Just like prevention is the best medicine, your business practice should heed the same prescription. Medical billing practices are constantly subject to audits, investigations, medical record reviews, and actions taken against providers for submitted claims for rendered services. The Justice Group provides consulting services to focus on correct billing practices and minimize the risk of potential overpayments or other harmful actions being taken against your practice. Our highly skilled and experienced team of professionals will provide a thorough review of operating procedures and develop a personalized plan of action to keep your practice in optimal health.

The Justice Group plays a central role in our payment integrity operations. Over the past 3 years, they have been very proactive in working with our compliance officer and the operations teams to ensure that we proactively evaluated and analyzed any Medicaid payment issues. Not only are they highly skilled in their administrative and investigative approaches, but they are also respected by the team and our state regulators.

The Justice Group has delivered expert knowledge in the prevention, detection, and resolution of potential fraud, waste, and abuse in our healthcare program. Everyone with The Justice Group is extremely professional and with the help of their expertise we have been able to stand up and run a successful SIU program.