OUR EXPERTISE

Healthcare Consulting Services

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It’s no secret that the healthcare industry is complicated.

With the rapidly evolving regulatory guidelines and consumer demands, continually adding new layers of complexity to the healthcare industry, choosing the right path for your organization is the most critical decision you can make.

Our healthcare consultants are experts in the industry — they have the necessary education and background on healthcare laws, regulations, and policies to help manage these complexities.

Our healthcare consulting services include:

  • Quality Strategy Assessment
  • Quality Payment Programs
  • HIPAA
  • Medicaid Promoting Interoperability
  • Chart Reviews
  • Practice Workflow Analysis
  • Care Management
  • Practice Transformation

OUR HEALTHCARE SERVICES

QUALITY PAYMENT PROGRAMS

Edafio Healthcare consultants have extensive experience working with many payer programs in our region. We can evaluate the payer’s quality programs you are involved in and we can help you with a GAP analysis, audit preparation, and best practices in order to position your organization for success. It is important to understand the requirements from each payer in order to avoid future penalties or negative adjustments from payers based on your participation or non-participation. In many cases, your performance today will impact reimbursements in years to come.

QUALITY STRATEGY ASSESSMENT

Edafio can provide an assessment of your organization’s current state as it relates to your unique setting, payers, and quality programs. Our assessment can also help you identify potential additional revenue opportunities that you may be eligible for. Edafio Healthcare Consultants utilize our Quality Strategy Document (QSD) to help practices identify additional revenue areas and identify current programs with activities and metrics which influence multiple payers. With the QSD, practices can better leverage their resources into areas that have the largest positive value-add impact and identify sources of revenue, which they may not have sought out in prior performance periods.

HIPAA

Edafio Healthcare Consultants provide a review of current policies while offering recommendations, assist in the customization of policy and procedure template as well as provide education and training on HIPAA regulations. Practices find our approach to be very beneficial in their journey to put their policies into practice and action on remediations that need to be performed using a systematic approach.Edafio Healthcare consultants have extensive experience working with many payer programs in our region. We can evaluate the payer’s quality programs you are involved in and we can help you with a GAP analysis, audit preparation, and best practices in order to position your organization for success. It is important to understand the requirements of each payer in order to avoid future penalties based on your participation or non-participation. In many cases, your performance today will impact reimbursements in years to come. Completing a risk assessment requires a time investment and Edafio can be your resource to take on that time investment and walk you through a thorough Risk Assessment. We will provide you with a very professional and easy to understand deliverable so if you are ever audited, you can hand them this deliverable and it should address most of the questions the auditors will ask. We also offer remediation assistance as an on-going project where we work with you on a regular basis to remediate any issues found in the assessment.

MEDICAID PROMOTING INTEROPERABILITY

Edafio Healthcare Consultants provide assistance with this program as part of our multiyear quality strategy planning approach. We assist our clients in success for preparation efforts, building out audit documentation all the way to assist with audits of previous years’ attestations.

CHART REVIEWS

Accurate and up-to-date documentation is incredibly important for compliance and patient satisfaction. Edafio can help you understand the impact your EHR has on documentation, and we can help you review all of your documentation for accuracy and compliance purposes. In order to be successful in an audit, it’s important that all of your documentation be up to date and accurate.

PRACTICE WORKFLOW ANALYSIS

Edafio has experience in mapping and template building in many EHR’s and will be there to help you with any of your needs surrounding these tedious tasks. Our healthcare consultants are able to work with you on implementing team-based care and optimizing your care team structure at the practice. We can assist with pre-visit huddles, built-in assessments and documentation of clear roles and workflows based on staff type and position. Defining clear job duties, roles, and responsibilities will be a critical, yet effective part of this process.

CARE MANAGEMENT BEST PRACTICES

Many insurance payers’ plans have begun covering care management for their patient populations. Billing payers or getting upfront care management fees by participating in innovative payment models like Patient-Centered Medical Home (PCMH) or the Comprehensive Primary Care Plus Initiative is a great opportunity for your practice; however, this type of practice transformation requires hands-on assistance in order to be successful and audit-ready for claims submitted. Careful consideration should be taken in order to ramp up these efforts and assure patient satisfaction and outcomes are top of mind.

Edafio healthcare consultants can lead and assist in this effort as desired. We have found that our “hands-on” approach is a great fit for ACO groups as well. We strive to ensure the practice and the ACO has the best chance for success in the various quality-driven programs.

PRACTICE TRANSFORMATION

Edafio takes a multi-pronged approach with Practice Transformation. We believe a combination of focus on Annual Wellness Visits, Transitional Care Management, and Chronic Care Management can truly move your practice to the next level.

Billing Medicare or other payers for additional services that the clinic is not providing currently is a great opportunity for your practice; however, practice transformation requires hands-on assistance in order to be successful and audit-ready for claims submitted.

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