OIG & Regulatory Compliance Services
DoctorsManagement, LLC has extensive experience with OIG corporate compliance programs, so you can trust our experts to assist with your regulatory compliance needs. We offer services to address your practice's unique compliance requirements so you can focus on your patients and essential business tasks.
Schedule a Consultation
Get expert guidance for your healthcare compliance needs
Leading Healthcare Compliance Consulting Firm
As one of the nation's premier healthcare compliance consulting firms, DoctorsManagement provides comprehensive medical compliance solutions tailored to your organization's unique needs. Our team of certified experts brings decades of experience in healthcare regulatory compliance, helping practices navigate complex federal and state requirements with confidence.
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Customized Compliance Programs Healthcare compliance solutions designed specifically for your practice type, specialty, and risk profile
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Certified Industry Experts Team includes AAPC, AHIMA, and HCCA certified professionals with real-world compliance experience
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Full-Spectrum Support From initial risk assessments to ongoing compliance monitoring and healthcare compliance training
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Proven Track Record 500+ healthcare organizations trust our healthcare compliance consulting expertise
Our Healthcare Regulatory Compliance Services
The Office of Inspector General (OIG) compliance programs help promote ethical and lawful corporate conduct. Healthcare compliance programs promote detection, prevention and resolution of healthcare provider conduct that does not meet federal and state law and a hospital or health system's business policies, which demonstrates a "Culture of Compliance".
DoctorsManagement can help your organization review OIG compliance resources and your current medical compliance framework to identify improvement opportunities. We can assist with various compliance support services, ranging from direction to advanced compliance services. Our capabilities include:
Coding & Documentation Review
Comprehensive assessment of medical coding accuracy
Compliance Gap Analysis
Thorough audit of compliance practices and procedures
OIG Manual Creation
Custom OIG compliance manual development for your practice
Audit Appeals, Defense & Expert Witness
Expert representation for audit appeals and litigation support
RCM Review
Revenue cycle management analysis and optimization
Payor Compliance Training
Comprehensive training on payer requirements and compliance
Healthcare Compliance Officer Solutions
Empower your healthcare compliance officer with the tools, training, and support needed to build and maintain an effective compliance program. DoctorsManagement provides comprehensive healthcare compliance training and resources for compliance professionals.
Compliance Officer Training
Comprehensive healthcare compliance training programs designed for compliance officers at all experience levels.
- OIG Seven Elements Framework
- Risk Assessment Methodologies
- Audit Response Protocols
- Documentation Best Practices
Program Development
Expert assistance building or enhancing your healthcare compliance program from the ground up.
- Policy & Procedure Creation
- Compliance Plan Development
- Monitoring Systems Setup
- Reporting Structure Design
Ongoing Support
Continuous guidance and resources to help your healthcare compliance officer succeed long-term.
- Regulatory Update Alerts
- On-Demand Expert Access
- Annual Program Reviews
- Compliance Hotline Support
Fractional Compliance Officer
Beyond training, we can serve as your dedicated fractional compliance officer, providing hands-on leadership for your compliance program.
- Part-Time CO Services
- Program Oversight & Management
- Audit Response Leadership
- Board & Leadership Reporting
OIG Compliance Guidance & Healthcare Audit Defense
Navigate complex regulatory requirements with expert OIG compliance guidance and comprehensive healthcare audit defense services from our nationally recognized team.
Expert OIG Compliance Guidance
The Office of Inspector General provides essential compliance resources that every healthcare organization must understand and implement. Our experts translate complex OIG compliance guidance into actionable strategies tailored to your practice.
From the OIG Work Plan to advisory opinions and special fraud alerts, we help you stay ahead of enforcement priorities and build a compliance program that meets federal standards.
Comprehensive Healthcare Audit Defense
When your practice faces a Medicare, Medicaid, or commercial payer audit, you need experienced professionals who understand the audit process and can mount an effective healthcare audit defense strategy.
Our team has successfully defended hundreds of healthcare organizations against RAC, MAC, ZPIC, and other audit types, protecting millions in revenue and helping practices avoid costly extrapolation penalties.
Medicare Appeal Services
When Medicare denies claims or demands overpayments, a strategic medicare appeal can recover significant revenue for your practice. Our team guides you through every level of the medicare appeal process with expertise gained from thousands of successful appeals.
From initial redetermination through ALJ hearings and beyond, we provide comprehensive support to maximize your chances of a favorable outcome in your medicare appeal.
Compliance Fundamentals
Core healthcare regulatory compliance principles and OIG guidelines
Coding & Documentation
Medical coding accuracy and documentation requirements
Fraud & Abuse Prevention
Identifying and preventing healthcare fraud risks
HIPAA Privacy & Security
Patient privacy protections and data security requirements
Audit Response Training
Preparing for and responding to compliance audits
Comprehensive Healthcare Compliance Training
Build a culture of compliance with our comprehensive healthcare compliance training programs. Designed for healthcare compliance officers, billing staff, providers, and administrative teams, our training ensures your entire organization understands their role in maintaining medical compliance.
Certified Instructors
Industry-certified compliance experts with real-world experience
Customized Content
Training tailored to your specialty and organization needs
Flexible Delivery
On-site, virtual, or self-paced learning options
Documentation
Complete training records for audit purposes
Medicare Appeal & Audit Defense Services
When Medicare denies claims or demands overpayments, our healthcare audit defense team helps you navigate the complex medicare appeal process to recover revenue and protect your practice from unjust penalties.
Level 1: Redetermination
Initial appeal to the Medicare Administrative Contractor (MAC) within 120 days of denial
Level 2: Reconsideration
Review by Qualified Independent Contractor (QIC) with fresh perspective on your medicare appeal
Level 3: ALJ Hearing
Administrative Law Judge hearing with oral testimony and evidence presentation
Level 4: Medicare Appeals Council
Review by the Departmental Appeals Board for complex healthcare audit defense cases
Level 5: Federal Court
Judicial review in federal district court for amounts over $1,760
The Importance of Programs for Regulatory Compliance in Healthcare
The modern healthcare regulatory environment is complex and ever-changing. Compliance affects several aspects of a healthcare organization, from patient and employee safety to risk management and fraud prevention.
Risk Management
Healthcare compliance programs enable organizations to manage noncompliance risks with proactive processes such as staff training and consistent audits to ensure continual compliance.
Quality Assurance
Complying with federal, state and organizational policies helps practices improve operational efficiency in ways that affect quality of care and maintain quality assurance.
Fraud Prevention
To prevent fraud and financial loss, healthcare organizations need effective compliance plans that keep them informed of relevant laws and enable detection of conduct that may not align with regulations.
Frequently Asked Questions
Get answers to common questions about healthcare compliance, OIG compliance guidance, and regulatory requirements.
What Is a Regulatory Compliance Program?
With the passage of the Patient Protection and Affordable Care Act of 2010, physicians who treat Medicare and Medicaid beneficiaries will be required to establish a compliance program. A regulatory compliance program keeps your practice updated on constant regulatory changes through various processes and policies. An effective program helps you maintain medical compliance and experience benefits such as:
- Demonstrate commitment to honest and responsible corporate conduct
- Provide accurate view of employee behavior relating to fraud and abuse
- Identify and prevent criminal and unethical conduct
- Tailor a compliance program to your organization's specific needs
- Improve the quality of patient care
- Create a centralized source for distributing compliance information
- Develop methodology that encourages employees to report potential problems
The goal of a healthcare compliance program should be to build out your compliance framework so it can easily adapt to regulatory changes.
How Do OIG Compliance Programs Help?
To help hospitals, physicians and other healthcare providers develop comprehensive compliance programs that comply with relevant federal healthcare laws and regulations, OIG offers compliance resources including:
- Advisory bulletins
- Brochures and educational materials
- Articles and papers
- Podcasts and videos
- Guidance on compliance with federal health care program standards
- Opinions regarding federal anti-kickback statutes
OIG resources are often tailored to providers, enabling organizations to find the educational resources they need to understand their regulatory requirements. With an understanding of healthcare regulations and compliance, medical practices can form comprehensive programs that enable them to maintain compliance.
Discover Comprehensive Regulatory Compliance Solutions
DoctorsManagement is a full-service healthcare consulting firm with in-house experts ready to support your goals. Our consultants work alongside your healthcare organization to help you experience the benefits of compliance, such as financial risk mitigation, patient satisfaction, employee morale and staff stress relief.
Request a Discovery Call
DoctorsManagement can help you streamline your regulatory compliance approach. Our professionals will assess your compliance program to confirm it has appropriate policies, practices and procedures in place to address regulations relevant to your practice.