EMS Compliance 

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Do You KNow...

Under the terms of the Affordable Care Act, all providers must establish a compliance program as a condition of enrollment in Federal programs.
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TEMS Compliance Approach

GETTING AUDITED?
TEMS CAN HELP

Compliance in Georgia

BEFORE

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EMS Compliance in Georgia

DURING

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Georgia EMS Compliance

AFTER

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BEFORE

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  • Perform Risk Assessments 
  • Develop Compliance Libraries
  • Develop Work Plans
  • Write Compliance Plans
  • Train Employees
  • Perform Internal Audits
  • Identify Billing Errors

DURING

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  • Research and review claims
  • Prepare documentation requested by the auditing agency
  • Respond and communicate with      auditors on your behalf.

AFTER

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  • Assist with appeals
  • Provide training and education
  • Address deficiencies
  • Annual reviews of compliance plan
  • Assist with integrity agreements
  • Perform Risk Assessments 
  • Develop Compliance Libraries
  • Develop Work Plans
  • Write Compliance Plans
  • Train Employees
  • Perform Internal Audits
  • Identify Billing Errors
  • Research and review claims
  • Prepare documentation requested by the auditing agency
  • Respond and communicate with      auditors on your behalf.
  • Assist with appeals
  • Provide training and education
  • Address deficiencies
  • Annual reviews of compliance plan
  • Assist with integrity agreements

Who Can Be Audited?

  • Hospitals
  • Ambulance Services
  • Billing Companies

What Are the Auditing Agencies?

  • Medicare Administrative Contractor (MAC)
  • Zone Program Integrity Contractor (ZPIC)
  • Recovery Auditors (RA)
  • Office of Inspector General (OIG)
  • Department of Justice (DOJ)
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Who Can Be Audited?

  • Hospitals
  • Ambulance Services
  • Billing Companies

What Are the Auditing Agencies?

  • Medicare Administrative Contractor (MAC)
  • Zone Program Integrity Contractor (ZPIC)
  • Recovery Auditors (RA)
  • Office of Inspector General (OIG)
  • Department of Justice (DOJ)
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What Can These Agencies Do?

  • MAC's can put you on pre-pay review or refer you to the ZPIC.
  • RA's can recoup payments.
  • ZPIC's Contact patients, conduct investigations refers fraud to the OIG, denies or suspends payments.
  • OIG has a broad investigative authority, may involve criminal prosecution, can exclude your business from participation in federal programs, may criminally prosecute.
  • DOJ prosecutes federal charges, imposes fines, works with the FBI, engages in civil litigation.
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