Compliance, Audit & Risk Management

Pinnacle Enterprise Risk Consulting Services (PERCS) offers compliance and internal audit support for providers, hospitals, health systems, academic medical centers and health plans. Our clients have also utilized the PERCS team for assistance in litigation support and strategic services. Our team is comprised of a diverse group of healthcare professionals with a wide range of healthcare compliance certifications, such as HCCA, coding / billing / reimbursement from American Academy of Professional Coders (AAPC) and American Health Information Management Association (AHIMA), risk management / internal audit from the Institute of Internal Auditors (IIA) and Information Systems Audit and Control Association (ISACA). Some of our team members are also licensed accountants.

The PERCS team is also supported by nurses and other clinicians providing a medical necessity component to our administrative, investigative and regulatory skillsets. Our team members apply a unique perspective and industry experience, as many have served in a variety of positions within the healthcare industry. These experiences give us a unique perspective when it comes to consulting, as we’ve seen the operations from both sides of the table. Hands-on experience means realistic and workable improvement recommendations for our clients. We customize project teams to meet our client’s very specific needs. Our number one goal is to leave our clients in a better position for having worked with us.

Compliance Support
  • Compliance staffing and interim compliance officer and / or privacy officer services
  • Regulatory research support and advisory services
  • Develop, advise and execute highly complex and risk-based compliance audits
  • Compliance Program development / design, implementation, and effectiveness reviews
Internal Audits Services
  • Annual risk assessment and work plan development
  • Operational, regulatory, financial and technical internal audit assessments
  • Internal audit department co-sourcing arrangements, providing subject matter expertise when internal resources are not budgeted or available
Litigation Support
  • Determine the audit process, scoring methodology, data calculation, or interpretation of regulations of audits performed by government contractor / agency or other consulting firms to identify a defense strategy
  • Investigative support and / or audits to determine if a compliance issue exists
  • Statistically valid audits and reimbursement analysis for self-disclosure to government agencies
  • Payor / provider disputes including reimbursement analysis
Independent Review Organization (IRO) Services

Serving entities subject to a settlement agreement with the Office of the Inspector General (OIG) in the form of a Corporate Integrity Agreement (CIA) or Integrity Agreement (IA):

  • Reviews performed in accordance with Generally Accepted Government Audit Standards, also referred to as The Yellow Book
  • Claims testing reviews
  • Systems reviews
  • Unallowable cost reviews
  • Arrangements and focused arrangements reviews
Mock Surveys

Surveys conducted by the Centers for Medicare and Medicaid Services (CMS) are unannounced and it is crucial for your facility to be prepared for these inspections. Mock surveys allow you to identify opportunities for improvement and mitigate deficiencies before the surveyors knock on your door.

  • Mock surveys simulate CMS of accreditation reviews, utilizing the agendas and evaluation tools used by actual surveyors.
  • A Tracer Methodology is used, following patients from admission to discharge.
  • Provide guidance, coaching, mentoring and preparation activities.

For more information on mock surveys, click here.