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Regulatory Compliance
TCG has the experience to help you meet the stringent regulatory requirements of the industry. Response to regulatory and compliance issues directly affects your reputation and licensing.
TCG is experienced in local, state and federal regulations for home health, hospice, private duty, HME, home infusion pharmacy and skilled nursing facilities. We help you prepare for surveys, implement corrective actions and maintain compliance. We assist agencies in responding successfully to intense state and federal audits, including OIG audits.
TCG has extensive knowledge and expertise in state licensing and Certificate of Need (CON) requirements, and has participated in feasibility studies, positioning strategies and partnering options in most states. Issues regarding licensing and CON requirements are critical elements in reorganizing entities within an integrated service delivery system or for mergers, acquisitions or joint venture partnerships. These issues can influence the decision and timing to implement changes in corporate structures or to establish partnering agreements.
TCG takes an educative approach in assessing an organization’s level of compliance and in assisting the organization to improve and maintain compliance as integral to daily activities. TCG can conduct comprehensive assessments or focus on particular issues or specific regulations.
Create a Culture of Compliance
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Specific expertise and services include:
- Mock surveys
- Plans of correction in response to surveys
- Training, education and mentoring programs to improve and maintain staff competencies
- Clinical and billing record reviews
- OASIS, ICD-9 coding and HHRG integrity for Medicare home health PPS reimbursement and compliance
- Pre-billing audits and process design and training
- ADR and TMR resolution
- Adverse event audit and care management improvement
- Legal nurse consulting for case reviews and expert witness testimony
- HIPAA gap analysis and compliance preparation
- MDS, RAPS and RUGS assessment for skilled nursing facilities
- Policies and procedures development and revision
- Change of ownership
- Certificate of Need
- Corporate compliance programs consistent with OIG guidelines
- Experience working with state/licensing offices and CMS Regional offices
- Experts in Medicare, The Joint Commission, CHAP and ACHC survey preparation
- Experts in PPS Refinement
- Experts in Hospice QAPI and 2008 Conditions of Participation
- Ability to quickly and thoroughly identify problems that lead to noncompliance
- Solutions to improve compliance immediately and implement changes to ensure continued compliance
- Ability to evaluate the knowledge and skill set of administrative and patient care personnel to understand and implement regulatory requirements
- Experience working under attorney–client privilege when there is concern of potential litigation due to possible fraud and abuse
Contact us to learn how TCG can help your organization create a culture of compliance.