Enhancing Accuracy & Optimizing Capitated Claims
Our MRA Process Review & Tracking service helps healthcare organizations improve risk adjustment workflows, ensuring accurate patient risk stratification and optimized reimbursement.
How We Help:
- End-to-End Tracking – Monitor the full MRA process from documentation to reconciliation.
- Real-Time Data Analysis – Identify coding gaps to improve accuracy and prevent missed opportunities.
- Compliance Alignment – Ensure adherence to CMS-HCC guidelines and industry standards.
- Trend Monitoring – Track coding patterns, risk scores, and areas for improvement.
- Workflow Optimization – Improve internal processes for efficient data capture and claim submission.
Key Benefits:
- Improved Financial Performance – Maximize revenue with accurate coding.
- Stronger Compliance – Minimize audit risks and maintain Medicare alignment.
- Better Patient Risk Stratification – Accurately represent patient risks for improved care.
- Enhanced Efficiency – Streamline workflows to reduce administrative burdens.
Let us help you track, review, and enhance your MRA process for better optimization and financial sustainability.
Navigating healthcare compliance is crucial for smooth operations and risk management. Our Compliance & Medical Billing Risk Assessment ensures your billing practices align with federal and state regulations, payer guidelines, and industry standards.
Key Benefits:
- Error Reduction – Minimize billing mistakes for accurate claims.
- Audit Readiness – Identify gaps to prevent audits and scrutiny.
- Revenue Protection – Avoid denials and maximize reimbursements.
- Improved Processes – Enhance efficiency and reduce admin burdens.
- Compliance Verification – Ensure adherence to regulations and coding standards.
Our experts analyze your billing workflows, coding accuracy, and documentation to pinpoint risks and provide tailored solutions. Whether you’re a small practice or a large organization, we help you mitigate risks, optimize revenue, and stay compliant with confidence.
Our comprehensive compliance audits help you proactively identify and address gaps, ensuring you stay ahead of regulatory changes.
Fraud, Waste, and Abuse (FWA) Prevention
Fraud, Waste, and Abuse (FWA) can lead to financial losses and reputational harm. Our FWA Prevention Services help safeguard your practice by identifying vulnerabilities, ensuring compliance, and implementing proactive strategies.
Our training programs keep your team up-to-date on the latest healthcare regulations, so your clinic stays compliant while maintaining high standards of care.
We develop clear, effective policies tailored to your clinic’s needs, ensuring you meet all compliance standards without overburdening staff.
Key Benefits:
- Early Detection – Identify unusual billing patterns before they escalate.
- Compliance Assurance – Align billing practices with federal and state regulations.
- Risk Mitigation – Reduce exposure to investigations and penalties.
- Staff Empowerment – Train your team to prevent fraud, waste, and abuse.
Our experts provide in-depth audits, data analytics, and tailored prevention plans to protect your practice, enhance efficiency, and maintain trust with patients and payers.
Through detailed risk assessments, we help you create smarter strategies to minimize compliance risks and avoid penalties.
Ensure compliance, proper reimbursement, and risk protection with our Medical Records Review & Internal Audits service. We assess your documentation and workflows to identify gaps and inefficiencies.
At Premier Healthcare Compliance, we review medical records for accuracy and alignment with coding and billing standards. Our internal audits verify compliance with payer requirements, state and federal regulations, and industry standards—helping you optimize operations and minimize risks.
Denied claims can disrupt cash flow and increase administrative burdens. Our Claim Denial Management service helps healthcare providers identify denial causes, implement solutions, and recover revenue faster.
Key Benefits:
- Root Cause Analysis – Identify and address common denial reasons.
- Improved Cash Flow – Expedite resolution for faster revenue recovery.
- Compliance Support – Ensure adherence to payer policies and regulations.
- Proactive Prevention – Reduce future denials with process improvements.
- Tailored Solutions – Customize strategies to fit your practice’s needs.
Our experts analyze denied claims, correct errors, and optimize your billing processes—so you can focus on patient care while we safeguard your financial stability.
- Physician Practices
- Hospitals & Health Systems
- Skilled Nursing Facilities
- Home Health Agencies
- Behavioral Health Centers
- Medical Device Companies
Compliance Reviews
Reduce Violation
Risk by
Up to 50%
Regular compliance reviews and risk assessments can lower non-compliance risk by 40% and reduce costly violations by 35-50%, helping healthcare organizations meet regulatory standards.
References: U.S. Department of Health & Human Services (OIG); American Health Law Association (AHLA).
Face Fines Up to
$100,000 for Non-Compliance
with CMS Rules
Failure to follow CMS guidelines, including overpayments, improper billing, and non-adherence to Medicare or Medicaid, can result in penalties of up to $100,000 per violation under the False Claims Act (FCA).
Reference: U.S. Department of Health & Human Services, Office of Inspector General (OIG). False Claims Act Overview.
Non-Compliance
Costs Average
$14.82M
Per Data Breach
Organizations that fail to meet regulatory guidelines, like HIPAA, face an average cost of $14.82 million per breach, including fines and reputational damage.
Reference: National Health Care Anti-Fraud Association (NHCAA). The Challenge of Health Care Fraud.
Abuse (FWA) Prevention
Fraud Prevention
Programs Cut
Healthcare
Losses by 20%
Healthcare fraud costs the U.S. government $60-80 billion annually, but effective Fraud, Waste, and Abuse (FWA) prevention programs can reduce losses by up to 20%.
Reference: National Health Care Anti-Fraud Association (NHCAA). The Challenge of Health Care Fraud.
What really sets Premier Healthcare Compliance apart is their personalized approach. They don’t just treat you like another client—they genuinely care about your success. Their team was always available to answer any questions we had, often going above and beyond to ensure we felt supported every step of the way. As a medical billing company, having Premier Healthcare Compliance as a partner has been a huge plus. Their attention to compliance means we can focus on our core services.
One of the key strengths of PR healthcare compliance is its thorough compliance audits and tailored solutions. They identified potential compliance risks and offered clear, actionable strategies to address them. This helped our clinic maintain high standards of care while reducing the risk of costly penalties. They were always available to answer questions, provide guidance, and support us through implementing necessary changes. Thanks to their efforts, we saw significant improvements in our clinic’s operational efficiency and overall compliance.
