Internal Audits

When you want to verify how well your facility is complying with regulatory standards, an internal audit may be in order. Excelas can objectively review a sample of your records—no matter how big or small—to assess the criteria you specify. Common areas of focus include skilled nursing facility and therapy documentation, hospice compliance with Medicare requirements, Medicare and Medicaid fraud and waste, and necessity for prolonged services in acute settings.

Our work will determine the following:

  • The reliability of your clinical documentation
  • Whether your documentation supports submitted claims
  • The risk of non-compliance with regulatory requirements.

We can provide a brief summary of our findings, or simply pull out data points for your review.

How Excelas Supports Enterprise Risk Management (ERM)
in Long-Term Care

Enterprise Risk Management (ERM) is simply assessing how risks affect an organization and devising plans on how to approach different risks.  ERM is an organization-wide strategy, both top-down and bottom-up, to identify and prepare for hazards and mitigate operational, financial, compliance, legal, and other risks.

Excelas supports our clients’ ERM programs through data abstraction, audits of medical and related records, and record production support.  These audits can reveal gaps in documentation, provide documentation support for claim submissions, and ensure compliance with regulatory requirements.  Excelas’ experienced legal nurse analysts can evaluate your facility’s compliance with your current risk management guidelines as well as provide recommendations for documentation improvement.

Related Compliance Services

Our firm regularly uses the Excelas Care Calendar which is an excellent tool to present medical care and staff interactions.  The Care Calendar’s functionality allows easy access to the documentation and provides attorneys and witnesses a very accessible tool to present testimony.  The ability to access an exact page so quickly, especially during live testimony, is a great feature of the calendar.  Moreover, the calendar function itself tells the story of the number of interactions and “touches” in a clear and relatable format.  It is an excellent product we will continue to utilize.

- Matthew T. Corso, Shareholder, Buchanan