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Evaluation and Design of Compliance Programs
SunHawk’s team of experienced former compliance officers and regulators can help design, implement, evaluate, and enhance compliance and risk management strategies for all types of entities, especially healthcare.
We’ve worked for and with healthcare facilities of all sizes, including hospitals and health systems, academic medical centers, schools of medicine, pharmaceutical companies, Medicare and Medicaid managed care organizations, insurance companies, medical device organizations, physician practices, Independent Practice Associations (IPAs), Skilled Nursing Facilities (SNFs), hospice, and clinical and imaging laboratories.
SunHawk’s proprietary Global Compliance Effectiveness Program Assessment™ utilizes benchmarking data to assess our client’s highest compliance program risks. We standardize and customize our assessment using over 400 separate factors laid out by the Department of Health and Human Services, Office of Inspector General (OIG).
In addition to our Global Compliance Effectiveness Program Assessment™, we have developed a similar proprietary HIPAA / OCR Privacy Compliance Effectiveness Program. This tool allows us to identify high-risk issues identified within the 50 resolution agreements published by the United States Department of Health and Human Services.
Our individualized reports not only identify your highest compliance risks they also provide actionable recommendations. Further, our professionals provide support and answers to questions every step of the way.
External Review and Monitoring of CIAs and IROs
Healthcare organizations doing business with the federal government can sometimes find themselves facing or operating under a Corporate Integrity Agreement (CIA), which requires hiring an Independent Review Organization (IRO). SunHawk’s professionals understand this can be a difficult and stressful process. We coordinate on-site claims review visits, as well as offsite audits, then assist in the implementation of the standards set forth within any negotiated settlement agreement. Our experts will meet your individualized needs and those of the Department of Health Services, Office of Inspector General (OIG).
Some of our services include:
Claims testing reviews
Compliance effectiveness reviews
Unallowable cost reviews
Reviews performed in accordance with Generally Accepted Government Audit Standards, also referred to as “The Yellow Book”
HIPAA: Compliance Risk Assessments & Training
HIPAA: Compliance Risk Assessments: SunHawk performs HIPAA Privacy, Security, and Breach Notification Risk Assessments and analyses in accordance with the Office of Civil Rights Audit Protocols, HIPAA Privacy, Security, and Breach Notification Rules, observations from the review of all public Resolution Agreements and provides you with a concise, practical report and the tools to implement required changes.
Our proprietary HIPAA / OCR Compliance Effectiveness Program HIPAA CHECK™ identifies high-risk issues in your company. Our individualized reports not only identify potential problem areas, but they also provide clear and concrete direction for improvement. Our professionals provide counsel and guidance as you perform the necessary remediation steps.
HIPAA: Compliance Training: SunHawk professionals are industry-recognized experts in their fields. Our roster of professionals includes one of only 10 “Certified Healthcare Compliance Fellows”, have presented at more than 100 professional association training, and Chair two annual training conferences for the Health Care Compliance Association (HCCA).
Our team will customize the HIPAA training to align with your business culture. Options range from basic, introductory-level programs for frontline staff to more comprehensive guidance for management and/or the Board of Directors.
Broad-Based Interim and Fractional Compliance Support
We provide a variety of generalized compliance and risk management services, including serving as interim Chief Compliance Officer or other Compliance Officer Roles. Our experts are regularly hired to fill the role expected from an experienced/qualified Compliance Officer full-time or part time FTE including performing risk assessments, investigations, audits, design, draft or implement a code of conduct and/or other policies and standards.
Other services include, but are not limited to:
Fraud, waste and abuse risk management;
Customized compliance training for Boards of Directors, company executives, and the workforce;
First Tier, Downstream and Related Entity (FDR) delegate oversight;
Serve on Boards of Directors.
Examples of topics our experts can cover include Medicare/Medicaid regulations, internal investigations, and inquiries, communicating with regulators, Stark and Anti-Kickback Laws, HIPAA, investigations, and other Federal/State laws and regulations.
SunHawk will develop individualized courses that are engaging, practical and directly applicable to participants’ roles.
Claims Analytics, Audit Services, & Coding Education
Claims Analytics: State and federal regulators require most healthcare providers to flag high-risk billing before it is submitted to health plans for payment. They also expect providers to have protocols in place to catch such charges before proffering encounter and quality data to government regulators. Our professionals leverage our combined experience as former in-house compliance experts, finance executives and government regulators to ensure our clients are prepared to face complex government audits, which typically use data prospecting, pattern detection, overpayment extrapolation, and identification of statistically relevant samples through the use of RAT-STATS and other fraud prevention methods in their assessment.
Coding Audit Services: Physicians’ coding proficiency can greatly impact the bottom line and lower your regulatory risk. SunHawk’s medical coding and audit experts work across specialties and organizations to ensure proper coding of medical claims.
Our services in this area include:
Medical Coding / Documentation Audits: We assess whether a provider’s level of service is supported by federal and state coding guidelines and identify improvements that can promote proficiency and compliance.
Bell Curve Analysis: State and federal regulators are increasingly using physician utilization data to identify which providers to audit. SunHawk’s professionals help an organization properly benchmark physicians’ utilization against similar providers.
RAC & External Audits: SunHawk’s professionals have hundreds of years of combined experience preparing for government audits. We ensure your positions and your needs on complex issues and subjects are clearly communicated to government regulators and enforcement personnel.
Provider & Staff Coding Education SunHawk’s education program takes a holistic approach to help any team boost their knowledge and improve and/or reinforce their complex coding competency. Our professionals have expertise in a variety of physician specialties and :with specialty procedures. We work with a wide range of entities, including major hospital groups, SNFs, Cancer Centers, and small, independently owned physician practices.
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