Since 2004, Affiliated Monitors has been providing independent monitoring services for healthcare professionals. We have developed broad and deep experience in each of these practice areas which have seen the greatest scrutiny by government regulators.
Billing & Coding Audits & Monitoring
The most frequently scrutinized practice areas include billing and coding, Medicaid and Medicare compliance, record keeping, over-utilization, insurance fraud, boundary violations, disruptive behavior and regulatory compliance. We also help professionals comply with the Health Insurance Portability and Accountability Act (HIPAA). Our compliance programs include audits, manuals, training and monitoring.
Affiliated Monitors has developed effective programs for chaperoning and monitoring of boundary cases. Our programs are used by many State Healthcare Boards to provide in depth oversight and chaperoning of license professionals.
Clinical Competence Assessments
Clinical Competence Assessments allow decisions to be made about medical qualification and fitness to practice, including those currently in practice and those who might be interested in returning to practice from prior suspension.
For those providers currently in practice, there are occasions when their clinical judgment or skills are questioned. Utilizing our specialized team of appropriate healthcare professionals, Affiliated Monitors has successfully conducted assessments of very specific skill or judgment matters as well as broader competency issues.
Clinicians who desire to reenter practice often need to demonstrate competence to licensing bodies or prospective employers. They need to prove that they possess the skill and ability to practice medicine in today’s increasingly complicated and changing medical world.
Affiliated Monitors’ approach starts with an initial evaluation of clinical skills and continues in the development of a personalized Reentry Plan. The goal of assessment is to develop reliable measurements of performance which will ensure that the clinician is cleared to continue or resume practice.
Affiliated Monitors has served as the independent monitor in hundreds of matters for healthcare boards across the country. These matters often arise out of a settlement agreement with the practitioner or as a term of probation. The matters that we have handled involve almost all aspects of a practice, including pain management, delegation of patient care functions, patient records, billing, behavioral issues, administrative operations and many others.
Independent Review Organization
Healthcare organizations that enter into a Corporate Integrity Agreement (CIA) with the government are required to retain an Independent Review Organization (IRO), usually to review a sample of the claims the organization is submitting to Federal healthcare programs. Affiliated Monitors provides IRO audit services which include Stark, Kickback, Anti-Trust as well as the review of the organization’s process for compiling and submitting claims, including coding and medical necessity.
Affiliated Monitors has been engaged to oversee some of the most frequently scrutinized practice areas, including Medicaid and Medicare compliance, billing and coding, record keeping, over-utilization, insurance fraud, boundary violations, disruptive behavior and regulatory compliance. We also help professionals comply with the Health Insurance Portability and Accountability Act (HIPAA). In addition to the independent monitoring services, our compliance programs include practice assessments and audits, the design and implementation of compliance manuals, training and monitoring.
Practice-based Independent Monitoring
AMI can protect the career and reputation of licensed professionals. Before monitoring was introduced, many professionals faced having their license revoked or suspended. They might pay heavy penalties or lose their credentials, even for relatively minor violations. Monitoring is not just an innovative approach – it helps practitioners improve their understanding of state and federal regulatory requirements to ensure ongoing compliance and enhanced quality of service.
Prescription & Dispensing Oversight
Pharmacies and the pharmaceutical industry are very heavily regulated. The need to comply not only with the usual business statutes, but also with industry specific regulations, is a matter of public safety.
It is easy to make mistakes that can be costly to your business. Affiliated Monitors can help you prevent such mistakes. Our services include:
- Background checks
- Advertising reviews
- Billing monitoring
- Codes of ethics
- Diversion reviews
- Product Integrity
- Contractual obligations
- Fraud investigations
- Integrity assessments
- Independent analysis and laboratory testing
- Regulatory oversight