Audit and Compliance Oversight
We operate as an experienced, trusted independent third party, working with contractors and agencies to ensure that guidelines are followed, policies are adhered to, and program goals are met.
OUR SERVICES
On-Site Reviews
Medical Reviews
Audit Program Development
Desk and Documentation Reviews
Data Analysis
Contractor Oversight
OUR STRATEGY FOR SUCCESS
HIGHLY
QUALIFIED STAFF
Registered Nurses and Physicians
Quality Assurance Analysts
Former OIG Investigator
Subject Matter Experts
THE RIGHT TOOLS & TECHNOLOGY
Microsoft Dynamics
RAT-STATS
Secure document sharing platforms (such as SharePoint)
PROVEN
PROCESSES
Use of protocols and checklists for all reviews
Real-time entry of findings by all reviewers
Follow generally accepted government auditing standards
OUR SUCCESS STORIES
Developing Auditing Protocols to Review Medicare Appeals Decisions
THE ISSUE
CMS needed auditing protocols to evaluate the accuracy, timeliness and quality of the Medicare appeals decisions made by the Qualified Independent Contractors (QICs).
THE RESULT
As the Evaluation & Oversight (E&O) contractor, NHA developed auditing protocols for each discrete workload and implemented a consistent auditing approach that was approved by CMS. When CMS later identified the need to perform similar audits on the Medicare Administrative Contractor (MAC) appeals decisions, they approached NHA to perform this work.
Our Success by the Numbers
