Our team has worked in health care operations and knows the technical questions to ask with coding, billing, health information and compliance to help identify any potential risks or compliance issues. We can help identify and interview key roles that go beyond the commonly identified organizational leaders. Our team understands the health care business and how it operates, particularly, within revenue cycle, compliance, and health information management. Through this process our findings help clients understand potential risks they might be acquiring, establish a reasonable amount to put into escrow, and negotiating a purchase price. While many firms handle merger and acquisitions, our place in the process is to provide the subset of knowledge in the reimbursement and compliance space. We are an objective view and know exactly where to look for weaknesses to help identify potential regulatory exposure and risk. Our firm works directly with investors and client attorney’s to evaluate coding, billing, documentation, and compliance operations, and help identify potential risk areas with the transaction. M&As require a team of professionals ranging from private equity firms, management team, attorneys, and other skilled professionals to fully analyze a potential acquisition through proper diligence. Mergers and acquisitions (M&A) in the health care industry are complicated and many issues can emerge during the diligence process, such as Stark Law implications, anti-kickback safe harbors, and Health Insurance Portability and Accountability Act (HIPAA) compliance issues. Rivet Health Law provides thorough medical record documentation reviews and advice to help providers navigate payor inquiries and Target Probe and Educate (TPE), pre-payment, and post-payment E/M audits. MACs often misinterpret Centers for Medicare & Medicaid Services (CMS) directives and seem to create their own rules when auditing E/M services, which results in overpayment demands for providers. Proactive audits can help healthcare providers determine whether their documentation is sufficient to support E/M coding in claims submitted. Navigating the numerous and complex rules and payor requirements is challenging, especially because Medicare Administrative Contractors (MAC) continue to enjoy latitude with respect to documentation requirements when determining E/M levels. His next book on evaluation and management (E/M) coding scheduled for publication in January 2021, will help providers across the health care landscape better understand and prepare for ever-increasing payor audits and scrutiny.
is the author of Evaluation and Management Services: A Step-By-Step Guide to Accurate Coding, Reimbursement, and Compliance. Rivet Health Law founder, Joseph Rivet, Esq.
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