Turning Risk Into Competitive Advantage

You're in the business of helping people. Health care entities and providers are always at risk targeted and routine audits by private and government health plans.

APEX helps reduce risks associated with post- and pre-payment audits with proactive compliance programs and vigorous defense of reimbursement demands from audits reducing or eliminating clawbacks.

Capabilities

Audit Defense

Facing adverse results, suspension or payback from a recent Audit? The results can be costly and should only be handled by a knowledgeable healthcare compliance professional.

Our internal audit specialists have worked for most major health insurance companies, and state medical boards to remediate, remove or reduce the cost and reputational damage that can come from these actions. Let our team of experts take this burden off your plate so you can focus on patient care. Our experts will:

Challenge Disallowed Charges
Address Extrapolation Issues
Dispute & Negotiate Paybacks

1

Ongoing Compliance Support

Ensuring compliance is more than just meeting requirements – it is a crucial investment in the security and integrity of your practice, the protection of your licensure, and the preservation of your professional reputation.

Our experts possess an unparalleled depth of knowledge in healthcare regulations. We are dedicated to partnering with you to establish a robust foundation of compliance within your practice. We offer comprehensive, ongoing support to help you maintain and strengthen this compliance over time, ensuring that your practice remains protected.

2

Proactive Risk Management

Risk management is essential to maintaining stability, avoiding litigation, and maximizing profitability on both short-term and long-term horizons. So, are you managing your company’s or firm’s risks effectively?

We will help you prioritize any identified risks and create policies and procedures that outline the standards of supporting compliance moving forward.

Patient records and confidentiality procedures
Legal operations and medical licensing
Risk management and patient safety
Technology tools and risk exposure

3

Compliance Culture Succession

We help strengthen your practice by making sure there is a culture of compliance in the firm you're exiting or the one you're acquiring. Putting the right people and processes in place to enable MCOs and patients to trust the incoming team and processes. Our system involves:

Financial procedures and revenue cycles
Plans for future growth and development
Pre-Exit/ Merger Targeting
Continuity & Due Diligence
Pre & Post-Culture Integration

4

Medicaid Audits Are On The Rise

The Importance of Compliance

In healthcare, maintaining compliance is not just advisable, it’s essential. Why does compliance hold such significance in medical practices? Healthcare compliance encompasses the continuous practice of adhering to legal, ethical, and professional standards in the clinical environment. It involves a spectrum of activities, regulations, and guidelines designed to protect patient welfare, safeguard data, ensure service quality, and uphold ethical conduct. It's impossible to maximize your value to your community and stakeholders with out it.

Our team takes extreme ownership to reduce your pay back liability, offering proactive strategies, insights, and guidance to help you navigate audits and compliance issues with confidence.

Discover how Apex Healthcare's industry-leading expertise and dedication to uncompromising results can help you achieve regulatory freedom.

We mitigate risks and defend against regulatory actions, giving you the freedom to focus on what matters most—your practice and patients.

Let us know how we can help.

Due to the post-pandemic audit holds ending, your chance of being flagged for disallowances and paybacks are greater than ever.

Even if your compliance system is solid, all it takes is one mistake or accusation or misinterpretation of COVID allowances to open the door for auditors to start poking around. The good news is, there are ways for you to protect your practice even if you are targeted.

APEX Healthcare excels in risk management, handling complex MCO audit cases, appeals and even Department of Justice investigations. We mitigate risks and defend against regulatory actions, giving you the freedom to focus on what matters most—your practice and patients.

Our team takes extreme ownership, offering proactive strategies, insights, and guidance to help you navigate audits and compliance issues with confidence. Discover how Apex Healthcare's industry-leading expertise and dedication to uncompromising results can help you achieve regulatory freedom. Let us know how we can help.