Experts in healthcare data, regulations and economics

Selected by U.S. DOJ for expert work on healthcare regulations

Expert witness

HIPAA, HITECH Act, Affordable Care Act, medical coding and billing; industry best practices and guidelines

San Francisco / Silicon Valley engagement with VC and private equity

Health IT investor diligence, venture capital, private equity firms, health plans and providers, regulatory impacts

Boston expert witness, HIPAA Privacy and Security, HITECH Act safeguards

Anti-trust, computer assisted coding, ICD-10, clinical data economic impact

San Diego - mobile health solutions

Customer validation, strategic partners

Salt Lake City - Government health plan

ICD-10 Usual, customary and reasonable (UCR) cost of medical care

Miami - Medicare Advantage health plan

Risk adjustment, RAF scores, HEDIS® 5-Star Ratings

Healthcare IT investor diligence

St. Louis health plan, physician group, healthcare IT portfolio investor diligence in accountable care

Boston expert witness, HIPAA Privacy and Security, HITECH Act safeguards

Industries Served

/Industries Served
Industries Served 2017-05-04T04:05:59+00:00

Industries Served and Services Overview

Our clients are:

  • Health plans and self – insured employers
  • Hospital systems and other healthcare providers
  • Healthcare IT firms developing EMR, HIE, analytics, ICD-10 coding and other solutions
  • Pharmaceutical and medical device firms
  • Investors in Life Science, Software as a Service (SaaS), Cloud, mHealth, and Healthcare IT
  • Legal firms and regulatory compliance teams

Health Care Expertise

Our business, clinical, IT, and physician team has over 200 years of experience in health care. We serve in leadership roles with national and state medical standards boards, state health information exchange groups, and we touch on the work of over 200 employers, health care providers and payers. Our references include some of the largest and best-known health care organizations in the U.S. Our team comes from well-known firms in the industry.

  • Our fastest growing practice focuses on HIPAA mandates and Value Based Care, health care reform, new health information management (HIM) standards. We specialize in advising health plans, large self-insured employers, hospitals, and physician practice groups on the impact of health care reform and key standards developments such as:
    • HIPAA Privacy and Security Industry Best Practices, Guidelines and Statutes
    • Value of Care under the Patient Protection and Affordable Care Act, Medicare Part C, Bundled Payments and Global Payments Standards
  • Meaningful Use of Electronic Health Records (EHRs) and Electronic Medical Record (EMR) / Electronic Health Record (EHR) planning, implementation, and selection, including specialty EMRs for oncology and other areas. We provide Meaningful Use Assessments to guide Eligible Hospitals (EHs) and Eligible Professionals (EPs) in accessing incentives – whether or not they are Medicare or Medicaid providers. When your organization is at risk of being audited, our firm provides audit defense strategies and assistance on appeals. Additionally we advise regarding HIPAA Privacy and Security Assessments, which are an integral part of Meaningful Use, as well as Administrative Safeguards, Physical Safeguards, Technical Safeguards, and Operational Policies and Documentation required to comply with Meaningful Use and avoid HIPAA Breaches. We also advise clients regarding HIPAA Breach Notification planning and compliance.
  • Accountable Care Organizations (ACOs) Our firm understands the key components of the Patient Protection and Affordable Care Act (PPACA) that impact ACOs. We can help with ACO readiness, ACO strategy, clinical processes, population health, patient centered medical home, service line planning, and market studies. Our team can help with legal advisory including waivers, quality reporting, governance, managed care and provider contracting, revenue cycle management. We’ve led investor diligence on services for Medicare Shared Savings Programs (MSSP) and supporting cloud based analytics
  • ICD-10 Consulting – CMS mandated the conversion to ICD-10 by October 1, 2014. (World Health Organization
    [WHO] international classification of diseases). ICD-10 impact assessments (ICD-10 business impact, ICD-10 IT impact, ICD-10 process impact, ICD-10 readiness in the organization, ICD-10 process impact, ICD-10 revenue cycle impact, ICD-10 medical policy impact), ICD-10 implementation and integration including hospital revenue cycle management, payment reform, health plan medical policy and business rules remediation and ICD-9 to ICD-10 transition business road maps and ICD-10 cross walk strategies and mapping.
  • Physician engagement, mHealth and Cloud Health, Health care integration, BIgData, and Analytics. We use Software as a Service (SaaS) partners to enable application integration across Cloud Networks. This means health care specific, unified, on-demand security, user management, reporting, analytics and integration across multiple SaaS applications via cloud networks to enable integration across the continuum of care, helping to enable Medicare Advantage gain share and Accountable Care Organization shared savings.
  • CMS Hospital Value Based Purchasing (VBP) for Medicare. CMS will start paying incentives to higher performing hospitals that excel at CMS HVBP measures in 2012 and will look at retrospective performance of these organizations in 2011.
  • Health plan HEDIS Star Ratings Quality Measures for Medicare Advantage. CMS will start paying incentives to higher performing health plans that excel at CMS 5-Star ratings measures in 2012 and will look at retrospective performance of these organizations in 2011.
  • Regulatory affairs consulting – our team led the implementation of a global pharmacovigilance system for tracking events to ensure that FDA Adverse Event reporting compliance was met. The team led installation and configuration of software, integration with ERP systems and CRM systems, and process improvement efforts. Our team has extensive pharmaceutical, medical device, and regulatory affairs experience.
  • Revenue Cycle Management Analytics for hospitals Medical Policy Management for health plans, Utilization Management, Case Management
  • Health care social media for physician and patient engagement, talent development, and organizational change management. We sponsor a large social media community focusing on Accountable Care Organizations, ICD-10, HIPAA 5010 and other key issues. We use business road map consulting techniques, and social media inside and outside of companies to help them socialize and embrace change.

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