Program Analysis and Oversight

Program Analysis and Oversight

NHA makes it a priority to understand our client’s business and priorities.  We have a history of helping keep work on track and in sync with those priorities. NHA is well-known for being able to identify and monitor existing issues, provide early warning for potential problems, and recommend and implement viable short-term and long-term solutions.

Program Evaluation

At NHA, we help implement innovative solutions to improve your organizational processes. NHA’s trusted Subject Matter Experts have broad and extensive experience in numerous Medicare and insurance repayment programs. We are uniquely positioned to provide evaluation services to better align policies, procedures, and operations with stated program goals and desired outcomes. We draw upon our expertise, gained from extensive experience, to develop real-world, operationally practical improvement recommendations that optimize your organization’s strengths, minimize risk, and achieve results more efficiently. We can assist you in the analysis, planning, implementation, and support of a systematic approach to gain operational efficiencies. Our approach is to assess and understand current processes and organizational culture, identify best practices and performance gaps, work with you to lay out a “to be” state, and help you develop a plan to get there.

Operational Quality Review

NHA is constantly seeking ways to help our partners improve operations and programs. Our Quality Assurance (QA) experts review key program components for performance quality, accuracy, and efficiency.  We offer a wide-range of services that promote quality work and work products, such as conducting performance reviews for accuracy and timeliness; conducting operational reviews for efficiency and achievement of program goals; validating incoming data for accuracy, completeness, and adherence to standards; and more.  The NHA QA team applies principles and standards from proven QA standards and approaches such as International Standards Organization (ISO), Capability Maturity Model Institute (CMMI), Six Sigma, Lean, and Continuous Process Improvement.

Coordination of Benefits/Third-Party Liability

NHA has been providing Coordination of Benefits (COB)/Third-Party Liability (TPL) services since its very beginning.  Our founder, Neil Hoosier, is known as one of foremost subject matter experts in both the pre-payment and post-payment COB.NHA employs many other experts whose COB/TPL experience spans decades. We have worked tirelessly to help identify other insurance coverage of Medicare beneficiaries so that proper medical claim payments can be made correctly the first time.  In addition, NHA helps identify situations in which payments were made incorrectly because other insurance coverage should have paid, and supports collection of those incorrect payments. We have worked with Medicare, Medicare contractors, Medicaid state agencies, insurance companies across the nation, employers, Third Party Administrators (TPAs), and attorneys throughout our entire corporate existence.  NHA understands the nature of the insurance industry and typical causes of data inaccuracies, allowing us to be able to continually look for ways to improve the COB/TPL process.

Medical Review

The NHA clinical team includes Registered Nurses and Physicians who have knowledge of current clinical practice standards, Medicare coverage policy rules, and medical necessity guidelines.  Our team performs detailed analyses of medical record documentation to determine if services provided for healthcare insurance claims meet coverage guidelines, are considered medically necessary, and are correctly coded.  As part of our services, NHA evaluates whether medical necessity determinations made by other claim review entities adhere to standard operating procedures and policy guidelines.  NHA maintains a network of certified clinical professionals, making our Medical Review services scalable to your needs.

Information Systems Security Policy, Procedure, and Architecture Oversight

NHA has a deep and growing body of knowledge related to HHS Information Systems Security Oversight and Management, particularly at the Centers for Medicare & Medicaid Services (CMS). We offer security program management, including implementation of information systems’ change management, vulnerability management, and patch management. We are experienced in the design and implementation of numerous frameworks including NIST 800-37 Risk Management Framework for Federal Information Systems, and HIPAA / NIST 800-171 / FISMA/NIST 800-53 / CMS ARS / IRS P1075 controls and safeguards to protect sensitive data such as PHI/PII and IRS FTI. In addition, NHA staff are experienced in the design and engineering of Federal IT Infrastructure architecture, especially CMS Technical Reference Architecture (TRA). We also provide Security Awareness training, Phishing Awareness exercises, and Business Continuity planning.