Compliance, Accreditation & Regulatory Support

Successfully navigate the expectations of regulators, accrediting bodies and payors

An effective compliance program means more than a hotline and a designated compliance officer. Altegra Health can help your organization in building and maintaining a compliance program aligned with the Office of Inspector General’s (OIG) recommendations, payor requirements, state regulations and best practices. Altegra Health offers extensive compliance consulting expertise provided by professionals with deep specialization and experience in:

  • Establishing new compliance programs
  • Assessing and optimizing existing compliance programs
  • Compliance with Corporate Integrity Agreement stipulations
  • Serving as Independent Review Organization
  • Conducting mock Independent Review Organization audits
  • Providing training and education
  • Interim compliance staffing

Altegra Health also helps clients comply with mandates from accrediting agencies and payors; we offer:

  • Mock surveys and audits (Joint Commission, HIPAA, HEDIS, DNV, HFAP, etc.)
  • Audits assessing the documentation and billing for claims samples against payor guidelines, regulatory requirements and industry standards
  • Coding audits assessing the accuracy and appropriateness of coding for claims samples, trending billing patterns to identify potential abusive practices and providing education to coding and clinical staff on deficiencies
  • Audits of pharmacies and pain clinics, including compliance with FDA, DEA and State specific requirements
  • Audits of clinical laboratories to ensure compliance with CLIA, CAP, COLA standards and State specific requirements
  • Healthcare Reform and Sunshine Act assessments
  • Clinical Research and Clinical Trial assessments
  • 340B assessments
  • Patient Rights, Access and Notification assessments, including MSP, ABN, Charity Care and Insurance Verification processes

For more information, contact:

Melissa Scott, CHC, CPC
Director, Advisory Services Division
Office: 310.776.4500 Ext. 2370 | Cell: 951.440.4920