Pinnacle’s team of coding and compliance experts – also known as Pinnacle Enterprise Risk Consulting Services (PERCS) – offers an array of services for providers, hospitals, health systems, academic medical centers, and health plans. Our compliance, medical coding, and internal audit professionals hold a wide range of certifications from:
In addition, our team members have held a variety of positions within the healthcare industry and include professionally licensed accountants, nurses and other clinicians, coders, and compliance officers. This varied background amongst our team imparts operational experience to our projects and gives us a unique and hands-on perspective when it comes to consulting. Our clinical resources support our compliance assessments by providing a medical necessity component to our administrative, investigative, and regulatory skillsets. We customize project teams to meet each client’s specific needs, and our knowledge translates to realistic and workable improvement recommendations.
Pinnacle understands the significance of compliance within the healthcare industry and our team regularly supports clients in a variety of related matters, including interim staffing and co-sourcing. Pinnacle’s team members are certified and experienced professionals with proven career success in the areas of compliance, leadership, management support, and internal audit. We offer compliance interim staffing services in which our resources work to help clients with recruitment and management transitioning. Our goal in this process is to identify the best candidate to complete the work such that clients are left self-sufficient, maintaining only the resources needed to support organizational compliance. Pinnacle’s ability to supply interim compliance staff enables our clients to effectively navigate changes in leadership while maintaining appropriate practices that advance their objectives. In addition to interim staffing capabilities, we offer compliance co-sourcing services which provide clients with organizational work plans and mentoring for in-house staff. The objective of this process is to reduce the assistance needed by the client over time, while remaining available as needs arise. Collectively, our team possesses the skills that healthcare internal audit departments require and we impart these resources to our clients in a collaborative approach. We tailor each compliance engagement to our clients’ specific needs such that they achieve goals and improve operations.
Pinnacle’s team of experts provide compliance-related services to support a variety of scenarios, including interim services, co-sourcing, internal audit, and more. These services involve numerous project types, including:
Pinnacle’s team of coding, compliance, and enterprise risk experts have diverse experience that allows us to provide thorough litigation support services that close the gap between business, clinical, regulatory, and reimbursement issues. We understand that litigation represents an area of significant risk for healthcare organizations as it has the potential to disrupt operations and generate significant costs. In addition to support for active disputes, Pinnacle also provides IRO services for organizations operating under a corporate integrity agreement (CIA) with the Office of Inspector General (OIG). These services are provided by experts in clinical care management, healthcare operations, regulatory requirements, and reimbursement. We combine these skills sets with superior data analytics capabilities to provide successful, high-quality services from discovery through expert witness testimony. We work closely with in-house and/or external counsel to provide valuable insight to manage risk, create value, and deliver successful results in a cost-effective manner.
Pinnacle provides our clients with litigation support and IRO services to address the challenging financial, operational, clinical, and regulatory requirements of the healthcare industry. We work with clients and counsel to identify and understand each matter’s unique issues such that we can articulate our evaluation and findings in a written report and/or testimony, as appropriate. These services are available for numerous subject areas, including:
Pinnacle maintains a team of highly specialized and experienced coding professionals that assist our clients in a variety of matters. We understand that coding professionals must constantly navigate industry reforms such as regulations and fee schedules, while also playing a pivotal role in generating revenue. Despite the numerous nuances involved, coding professionals directly impact their organization’s ability to bill patients and payors. As a result, we offer an array of coding support and education services in addition to our similar services in the realm of compliance. Pinnacle’s coding professionals and resources are located within the United States (onshore) and our team structures each engagement with the client’s specific goals and objectives in mind.
Pinnacle continuously ensures that our experienced professionals provide quality and efficiency in keeping with our high standards of performance. We aim to provide both outsourced coding and audit assistance that support our clients’ objectives. Our coding and associated education services include activities such as:
As the healthcare industry continues to experience growth in value-based care payment models, Hierarchical Condition Category (HCC) coding is likewise becoming increasingly prevalent. Initiated by the Centers for Medicare and Medicaid Services (CMS) in 2004, HCC is a risk adjustment model originally designed to estimate future health costs for patients. Pinnacle’s HCC coding team offers health plans, facilities, providers, and Accountable Care Organizations (ACOs) the ability to improve performance measures and meet key objectives. Our resources are AAPC, AHIMA, and NAMAS certified professionals who have decades of auditing, coding, revenue cycle, and practice management experience and are well versed in all aspects of HCC risk adjustment, including numerous software systems. In addition to our qualifications and experience, Pinnacle offers competitive pricing and cost-effective, long-lasting solutions. Pinnacle surpasses industry IT security norms, mandates staff for precision assurance, offers customized reporting, and ensures prompt and expedited turnaround time. Our collective goal is to empower our clients and elevate their HCC risk adjustment success with our comprehensive coding, audit, education, and consulting expertise.
Pinnacle’s HCC risk adjustment coding, audit, and education services offer health plans, facilities, providers, and Accountable Care Organizations (ACOs) the ability to improve performance by providing:
Pinnacle offers revenue cycle solutions for clients such that they realize meaningful and measurable improvements. Many organizations face challenges related to revenue cycle performance, particularly after an electronic medical record (EMR) implementation. Our team of experts can perform a rapid assessment, develop an implementation strategy, and provide operational support until our clients’ management teams are ready to sustain improvements. In addition, we offer support in the form of interim leadership roles and mentoring for our clients’ management teams with the goal of continuous and sustained improvements. Pinnacle’s experts are seasoned AAPC and/or AHIMA certified professionals with expertise to support all aspects of revenue cycle, coding, and compliance services. We offer competitive per chart and hourly pricing and can assist with coding-related claims edits and denials due to various factors including low staffing levels and high volumes. We also offer temporary assistance when clients are recruiting for a vacant position or when backlogs and high volumes require resolution to minimize client workflow disruption. Our team members are experienced with Medicare, Medicaid, and commercial insurance, are well versed in governmental payment policies and regulations, and perform detailed analysis of coding denial trends to determine the best approach to remediate errors.
In addition to the revenue cycle assessment and coding/denial management services offered by our PERCS team, Pinnacle also provides outsourced professional fee revenue cycle management (RCM) and physician practice billing services through our Pinnacle Healthcare Revenue Solutions (PHRS) professionals.
Pinnacle’s medical coding and audit team consists of a diverse variety of healthcare professionals who hold a wide range of certifications. Our goal is to improve our clients’ financial and operational performance through the outcomes associated with our projects. We work with clients to improve revenue cycle and billing performance through services related to a variety of topics, including:
Pinnacle understands that a key component of our clients’ success is their ability to create effective teams and build leaders who thrive. Particularly within the dynamic field of healthcare, leadership and management effectiveness enables organizations to stay up-to-date and in front of regulatory and compliance matters that affect their operations on a continuous basis. With this objective in mind, our PERCS team offers leadership training, team building, and new manager training services. The aim of these services is to equip our clients with effective communication skills such that their revenue cycle and compliance teams can promote impactful outcomes. Pinnacle’s key leadership training expert possesses career-related knowledge and customizes training such that each program is unique to the client and accounts for each specific team’s dynamic. By building stronger team communication – both internal and external – leadership provides a solid foundation for both the organization and its team members.
Pinnacle’s leadership training services allow our clients to build and develop trust amongst their teams. The positive effects of these services are numerous and include improved team collaboration and communication, identification of individual strengths and talents, team leadership development, and enhanced team performance and results. We offer a variety of specific leadership training services and outcomes, including: