Risk Management in healthcare

Symedica Network has audited and critically reviewed hundreds of millions of dollars of clinical healthcare services provided in predominately pain management, behavioral healthcare practices and  facilities, and primary care physicians since 1996 at the request of conscientious providers. We have demonstrated to the providers meaningful ways of streamlining clinical services with a “best practices” mindset, while yielding positive client-centered clinical outcomes.  Risk management in healthcare are preformed in the following  compliance audit processes:

• Clinical Services Audits
• Operational Audits
• Regulatory Audits

Medical necessity and levels of care audits examine cumulative factors the provider has made in making determinations of appropriate levels for patient placement. CMS,  and other payers, are requiring providers demonstrate a clear mental thought process in determining the what, where, why, how, and when a  patient receives care.

By examining documentation patterns and treatment planning, we are able to compare performance and clinical assumptions with those in other clinical systems nationally for comparison and benchmarking.  It is from such extensive audits SyMedica developed and offers to providers in the integrated behavioral pain management specialty a specialized rating placement index as an effective tool for determining with normative data guidelines which level of care a patient would best benefit from treatment. The results of our audit is shared with the designated professional in a  positive, constructive way to enhance the provider’s patient care, and to improve reimbursement responses from payers.

Delivery of healthcare services can cause enormous financial and operational system pressures on the practitioners and administrative staffs.  They can feel they are striving toward opposing goals, rather  than working as a team building operational systems which produce synergism in the business matters of effective healthcare delivery.

Symedica’s operational audits provide systems and insight into ways synergism can be enhanced, creating a collaborative effort between clinicians and administrative staff in total care delivery. Furthermore,  such checks and balances instill safeguards for the provider toward accuracy in billing systems, fiscal accountability, and cost allocation methodology for the cost basis provider.

Corporate compliance efforts by healthcare providers are now the rule, not the exception. Symedica’s Corporate Compliance monitoring and audit processes are sensitive to prudent regulatory interpretation. Our goal is to assist providers with proactive measures of risk management in healthcare to prevent problems from occurring.

Yet, sometimes, providers have sensitive crises develop beyond our scope of expertise. If this occurs, we advise the provider of the options we are aware may be best for their regulatory circumstances.  With the help of our various experts in the legal, accounting, and licensure fields, SyMedica has established arm’s length relationships with professionals who we can recommend if a regulatory or potential liability by the provider becomes apparent via a regulatory audit.  If significant problems are anticipated, SyMedica strives to provide the provider with specialized assistance in the jurisdiction of the provider’s facility area.

Want to get started, or just have some questions?  Contact us at 888.508.1959 or email us at compliance@symedica.net today!