Audit and Compliance Oversight2020-11-20T19:47:03+00:00

Audit and Compliance Oversight

We operate as an experienced, trusted independent third party, working with contractors and agencies to ensure that guidelines are followed, policies are adhered to, and program goals are met.

OUR SERVICES

On-Site Reviews

Medical Reviews

Audit Program Development

Desk and Documentation Reviews

Data Analysis

Contractor Oversight

OUR STRATEGY FOR SUCCESS

HIGHLY
QUALIFIED STAFF

Registered Nurses and Physicians

Quality Assurance Analysts

Former OIG Investigator

Subject Matter Experts

THE RIGHT TOOLS & TECHNOLOGY

Microsoft Dynamics

RAT-STATS

Secure document sharing platforms (such as SharePoint)

PROVEN
PROCESSES

Use of protocols and checklists for all reviews

Real-time entry of findings by all reviewers

Follow generally accepted government auditing standards

OUR SUCCESS STORIES

Developing Auditing Protocols to Review Medicare Appeals Decisions

THE ISSUE

CMS needed auditing protocols to evaluate the accuracy, timeliness and quality of the Medicare appeals decisions made by the Qualified Independent Contractors (QICs).

THE RESULT

As the Evaluation & Oversight (E&O) contractor, NHA developed auditing protocols for each discrete workload and implemented a consistent auditing approach that was approved by CMS. When CMS later identified the need to perform similar audits on the Medicare Administrative Contractor (MAC) appeals decisions, they approached NHA to perform this work.

Our Success by the Numbers