Healthcare Regulations MountainRisk management in healthcare is a must in today’s regulatory minefield.  As a healthcare professional you probably end up managing your business hour-by-hour instead of delivering clinical outcomes to your patients.

A solution to the problem is practicing proper risk management in healthcare as a way to mitigate the ever changing regulatory issues.  By implementing a comprehensive program of best practices, proper continuing medical education, and regular audits you can experience:

  1. Faster payment from payer on your accounts receivable.
  2. Dramatically reduces your overall susceptibility to regulatory liability and litigation.
  3. Improved relationships with patient, pharmacies, regulatory agencies, and payer.
  4. Diminish the time you spend managing the business of your organization.
  5. Increase your time  practicing medicine commensurate with your training and delivering higher quality clinical outcomes for your patients.

Symedica Risk Management in Healthcare

Symedica Network has audited and critically reviewed over  82 million dollars  of  healthcare clinical services provided in predominately behavioral health care practices and facilities, and primary care physicians  since 1996 at the request of conscientious providers. We have demonstrated to the  providers meaningful ways of streamlining clinical services with a “best practices” mindset, while yielding positive client -centered clinical outcomes. Risk management in healthcare are preformed in the following compliance audit processes:


Clinical Services Audits

ChecklistMedical necessity and levels of care audits examine cumulative factors the provider has made in making determinations of appropriate levels for patient placement. HCFA, and other payers, are requiring providers to demonstrate a clarity in mental thought process in determining the what, where, why, how, and when a patient receives care. By examining documentation patterns and treatment planning, we are able to compare performance and clinical assumptions with those in other clinical systems nationally for comparison and benchmarking. It is from such extensive audits Symedica developed and offers to providers in the behavioral health specialty the Patient Rating Placement Index © (PRPI) as an effective tool for determining with normative data guidelines which level of care a patient would best benefit from treatment. The results of our audit is shared with the designated professional in a positive, constructive way to enhance the provider’s patient care, and to improve reimbursement responses from payers.

Operational Audits

closeup of doctor and nurses in a meetingDue to the enormous financial and operational system  pressures experienced in the delivery of healthcare services, practitioners and administrative staffs often feel they are striving toward opposing goals, rather than with team building operational systems which produce synergism in the business matters of effective healthcare delivery. Symedica’s operational audits provide systems and insight into ways synergism can be enhanced, creating a collaborative effort between clinicians and administrative staff in total care delivery. Furthermore, such checks and balances instill safeguards for  the provider toward accuracy in billing systems, fiscal accountability, and cost allocation methodology for the cost basis provider.

Regulatory Audits

Corporate compliance efforts by healthcare providers are now the rule, not the exception. Symedica’s Corporate Compliance monitoring and audit processes are sensitive to prudent regulatory interpretation. Our goal is to assist providers with proactive measures of risk management in healthcare to prevent problems from occurring.

Yet, sometimes, providers have sensitive crises develop beyond our scope of expertise. If this occurs, we advise the provider of the options we are aware may be best for their regulatory circumstances. With the help of our various experts in the legal, accounting, and licensure fields, Bredel has established arm’s length relationships with professionals who we can recommend if a regulatory or potential liability by the provider becomes apparent via a regulatory audit. If significant problems are anticipated, Bredel strives to provide the provider with specialized assistance in the jurisdiction of the provider’s facility area.

Get yourself back to doing what you went to school to do. Call Symedica at 888.508-1859 or email us at today.