PMA provides a wide range of services focused on the health care industry.  PMA’s roots are fraud and abuse, compliance, and auditing, with more than 100 years of experience in these areas alone among our  partners and associates. to our expanded service offering, we add value to your organization through our experience and effectiveness in delivering the following services:

 

Regulatory Compliance

 

PMA specializes in regulatory compliance for healthcare entities operating under the purview of the Centers for Medicare and Medicaid Services (CMS).   This expertise allows PMA to effectively serve our clients throughout the continental United States.

 

Despite our expertise surrounding CMS and Medicare, we limit our focus on regulation and policy at the state level to a small number of states.  We realize that we can’t be all things to all people and we will not mislead our clients by claiming to experts in regulatory compliance for all states.  PMA currently focuses on state regulation and policy in the following 11 states:

 

New York, Massachusetts, New Hampshire, Rhode Island, Connecticut, Virginia, Florida, Washington State, Oregon, California and Illinois.  

 

 

 

Compliance Certification

 

Practice Management Alternatives offers a Compliance Certification aimed at reducing exposure and liability for Health Plans and Providers subject to State and Federal False Claims Act statutes.

 

With passage of the Deficit Reduction Act (DRA) in 2005, the Federal Government placed the burden on Health Plans and Practitioners to reduce fraudulent claims and improve the integrity of claims payments.  This not only included establishment of compliance programs and educational requirements, it also included Chief Executive certification of data submissions.  Providers and Payors, according to the regulations, are required to certify that program integrity requirements are met as a condition of payment under the Medicaid Program. Due to low funding levels since enactment, enforcement of these requirements has been sporadic.

 

In 2009, Congress dramatically increased contributions to support the Medicaid Integrity Program initiatives responsible for oversight of the DRA.  This increase in funding will expand data collection activities and foster greater coordination with the states. The end result is increased scrutiny that will allow the review of many years worth of payor and provider conduct, and ensures that both are held accountable for up to date compliance and education programs as well as certifications made to the State and Federal governments.

 

PMA’s Integrity Program Compliance Certification process tests your compliance program’s policies and procedures, educational program, and data submission accuracy standards as they relate to the Deficit Reduction Act and State/Federal False Claims Act statutes.  PMA then provides you with documentation of the results allowing your entity to address any weaknesses or errors identified and demonstrate an outcome of proactive vigilance.

 

 

Compliance Plan Maintenance

 

PMA provides annual compliance plan maintenance subscriptions for clients who want to ensure that their organizations’ compliance plan is updated on a regular basis.  The inception of this service also requires a complete review of the client’s existing plan to ensure it is up to date.  This service can also be paired with a learning management system (LMS) for a solution that will benefit much more than the training of compliance.  Contact PMA for more information.