Simione™ Healthcare Consultants

Compliance & Risk 

Compliance & Risk Services Ethics Services Related Education

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Compliance, risk and ethics activities have become increasingly important areas of focus for the home care and hospice industry. Providers are facing more scrutiny and rigid regulations related to clinical eligibility and documentation, billing and business practices, and financial and income requirements. In fact, the government's sophisticated fraud detection techniques and the interpretive nature of documentation make potential for risk higher in all areas of health care.

The compliance and risk team at Simione Healthcare Consultants has comprehensive expertise to support clinical, operational, billing and financial compliance that is unequaled in the home care and hospice industry. We have a long track record of successful collaboration with health care attorneys and corporate compliance and audit departments, as well as government agencies and contractors.

We use our extensive industry experience to help minimize your risk and preserve and protect your organization's valuable assets. Our goal is to help you develop and maintain a dynamic Compliance & Ethics Program. Simione draws on our consultants’ knowledge and ongoing surveillance of regulations and legislation. We provide clients with reports of findings and recommendations for action plans and support throughout all phases of the compliance processes by the following steps.

Assessing your current state of clinical, documentation, billing and operational compliance through:

  • Compliance program/activities risk assessment
  • Random sample probe audits and validation audits
  • Annual compliance audits
  • Managing additional documentation requests (ADRs) and focused medical review
  • Mock surveys and survey corrective action plans
  • Reviews of billing and documentation processes
  • Cost report audits and analyses
  • Audits for Compliance with Sarbanes-Oxley Act of 2002

Providing a clinical documentation improvement program with:

  • Customized education programs
  • Customized audit tools

Working closely with your legal counsel and compliance officer to determine any reporting or disclosure responsibilities by:

  • Conducting probe/discovery audits
  • Conducting attorney privileged valid disclosure audits
  • Acting as an Independent Review Organization (IRO) for Corporate Integrity Agreements (CIAs)

Compliance & Risk Services

  • Risk Assessments of Corporate Compliance & Ethics Programs

  • Development, Implementation, Enhancement of a Corporate Compliance & Ethics Program

  • Conduct Clinical Record and Billing and Claims Audits:

    • Routine, focused and annual

    • Statistically valid disclosure audits pursuant to attorney client privilege

    • Custom audits pursuant to attorney client privilege

  • Serve as an Independent Review Organization (IRO)

    • Provide annual reviews as the IRO pursuant to a Corporate Integrity Agreement (CIA)

  • Develop Customized Audit Tools

  • Conduct Focused Compliance System Reviews

  • Perform Additional Document Requests (ADRs) and focused medical review

  • Conduct mock surveys and review

  • Assist with drafting survey corrective action plans

  • Assist with implementation of survey corrective action plans

  • Conduct OASIS Analyses and Training

  • Audit and Analyze Cost Reports

  • Perform HIPAA Privacy Assessments

  • Perform Professional/General Liability Risk Assessments

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Ethics Services

  • Develop and implement an Ethics or Bioethics Committee

  • Facilitate discussions of Ethical or Bioethical Issues

  • Serve as a Mediator

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