CMS Compliance

      Centers for Medicare & Medicaid (CMS) audits present significant threats to the revenues and profits of healthcare providers. Not only do the penalties and refunds associated with claims that are found invalid lead to the holding back of significant sums from Medicare/Medicaid, but the process of responding to Recovery Audit Contractors or RAC audits for legitimate claims can take up significant resources, with penalties for delayed or incomplete responses.

      It is therefore vital for healthcare providers to ensure that their CMS claims are legitimate and correctly documented so as to minimize the likelihood of RAC audits. In addition, compliance staff are challenged to keep up with changes to regulations and understanding how case experience impacts the provider’s own claims.

      BPS Resolver’s CMS Compliance solution is a comprehensive repository of CMS criteria-based clinical documentation, continuing education resources, audit templates and more. Coupled with leading edge workflow and document management, the CMS Compliance solution is a powerful resource to prepare for, defend and manage all government or payer claim audit reviews including:

      • Medicare Recovery Audits (RAC audits)
      • Program Safeguard Contractors (PSC audits)
      • Zone Program Integrity Contractors (ZPIC audits)
      • Medicaid Integrity Contractors (MIC audits)

      The BPS Resolver solution is also a real time connection to the nation’s leading CMS compliance resources and gives customers access to all the documents and precedents that impact the probability of receiving payment from Medicare/Medicaid—documentation you can use to avoid costly RAC audits and minimize the chance of government claw backs. BPS Resolver has partnered with Castle Rock Medical Group, the best and brightest Medicare coverage experts who have invested over 25,000 hours in identifying, evaluating, analyzing and synthesizing coverage criteria from 10,000+ CMS and CMS contractor documents.

      The result is a CMS Compliance solution that includes:

      • Library of 10,000+ CMS documents covering CMS rules & regulations, QIO / MAC guidance, online self-audit templates, continuing education programs, CMS appeals documentation, published clinical research and others
      • Dedicated CMS internal audit functionality used to identify and assess financial exposure
      • Capability to open files on individual cases/claims and add all the documentation necessary to support the validity of a claim
      • CMS payment criteria / Medicare coverage criteria modules including detailed focus area requirements for billing, documentation and claims submission
      • Easily modified continuing education program templates
      • Comprehensive reporting for compliance professionals, management and other stakeholders, including pre-built reports and dashboards that help reveal patterns of risk and areas requiring mitigation
      • Customizable workflows and notifications to ensure work packages are handled and deadlines are met

      The BPS Resolver solution is provided as a hosted web-based application for rapid implementation, easy integration with content updated, and convenient and secure access without increasing the workload for in-house IT.

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      Contact Us

      To request more information about BPS Resolver CMS Compliance solutions, contact us now. To speak with a BPS Resolver representative, call us at 1-888-891-5500 or +1 416 622-2299.