DUE DILIGENCE IN HEALTHCARE
Identify Fraud and Abuse Risk Before Deals Close
Hardly a day passes when you do not hear about a new merger or acquisition in the health care sector. The trend toward consolidation in creating larger systems with a wider array of services has been dramatic over the last decade. Some mergers and acquisitions (M&As) are monumental in scope, but most relate to individual hospitals, clinics and practices. eCatalyst Due Diligence Services help take the fraud and abuse risk out of M&A deals.
PEACE OF MIND
Avoid fraud and abuse
Healthcare is a highly regulated industry. Confirming that a target company has substantially been in compliance with applicable law is critical in healthcare M&A transactions during due diligence. A common concern in most transactions is healthcare fraud and abuse.
eCatalyst can give you peace of mind when it comes to determining if a target company is committing fraud and abuse by assigning incorrect codes. We conduct in-depth audits that include ICD-10-CM/PCS, CTP, HCPCS, E&M, HCCs, charges, etc.
DO YOUR DUE DILIGENCE
Understanding due diligence
Due diligence should ensure that the seller does not have a track record of healthcare fraud or abuse.
“Fraud” is the intentional deception and misrepresentation of material facts that can result in an unauthorized benefit of payment from a medical insurer or government payer. Some examples are, falsifying claims or medical records or misrepresentation of dates on services provided.
“Abuse” involves provider practices that are inconsistent with sound financial and medical practices that result in unnecessary cost to the payer, or payment for care that is not medically necessary.
Consultation on commonly seen coding and billing fraud and abuse for each entity
Detailed audits to determine compliance with national and state coding and billing regulations and guidelines
Coding and Billing Remediation services
Education and training services
Documentation review and template development
Go-forward coding, billing and auditing services
Resources to support your success
TELEHEALTH AUDIT CHECKLIST
COVID-19 CODING GUIDELINES
eCatalyst Healthcare Solutions is a Health Information Management and Middle Revenue Cycle company that has served healthcare clients for more than 15 years. We provide business process outsourcing and strategic consulting services to large healthcare integrated delivery networks, specialty and children’s hospitals, small and rural healthcare facilities, clinics and multiple specialty physician practices nationwide. We are headquartered in Phoenix, Arizona and have a diverse nationwide team of credentialed Health Information Management and Middle Revenue Cycle professionals.
eCatalyst Healthcare Solutions
PO Box 15541
Phoenix, AZ 85060
© eCatalyst Healthcare Solutions, a d/b/a of CDM Enterprises, Inc. 2021 | All Rights Reserved