A large multidisciplinary pain clinic engaged us to conduct a comprehensive review of its medical billing compliance across outpatient, inpatient, and compensation scheme services.
Scope:
We assessed Medicare billing practices, rejection patterns, clinical documentation, referral processes, informed financial consent, and Workers Compensation/CTP claims. The review also included evaluation of the practice management system and internal workflows.
Approach:
Over a two-day on-site visit, we observed the full patient journey and interviewed doctors, nurses, and admin staff to identify compliance gaps and system needs. Our findings were delivered in a detailed report with actionable recommendations.
Key Findings:
We identified serious compliance risks – particularly in inpatient billing and documentation – exposing practitioners to potential findings of inappropriate practice or even fraud. In one workflow, we found that patients could be admitted and discharged without any doctor-signed documentation.
Outcome:
We provided a clear roadmap to address urgent risks and improve systems, processes, and billing compliance across the clinic.