Regulatory Compliance

Regulatory compliance is a complex issue for many healthcare facilities, especially as new, updated regulations supersede old ones. Hospitals and health systems may find it challenging to stay up to date with regulatory changes impacting Utilization Management (UM) and the clinical revenue cycle and determine the implications of these regulatory changes on the organization’s processes. Fortunately, Versalus Health can assist your organization with keeping up to date with regulatory changes. We keep our finger on the pulse of regulatory oversight, helping facilities understand the newest regulations, their implications for the Clinical Revenue Cycle , and the latest trends in audits. Here is a summary of our regulatory compliance solutions:

Constant Risk Mitigation Monitoring

We help our clients by staying up-to-date on all the current regulations impacting the clinical revenue cycle. We monitor the Centers for Medicare and Medicaid Services (CMS) and other governmental agencies for new laws, regulations, and notices. Once a new requirement is created, modified, implemented, or revised, we assist our clients with implementing it effectively. We also continuously assess our clients’ compliance by analyzing data to answer questions such as:

  • Are we following a compliant Two-Midnight Rule approach to patient status?
  • Are our short-stay inpatient cases with no CMS exceptions in compliance?
  • Do we have risk patterns on Monday discharges or discharges to skilled nurse facilities?
  • Do we have risk in our total knee arthroplasty (TKA) or other procedures that have come off the Inpatient-Only list?
  • Are physicians driving compliance or revenue integrity risk?

Versalus Health’s ongoing data monitoring allows us to help our clients improve processes and identify any compliance risks without delay.

Compliance Education and Training

We provide executive leadership and clinical team education and training. In addition, we provide auditing and monitoring of utilization management practices. We have regular webinars and workshops that can help facility leaders, staff, teams, and practitioners become proactive about regulatory compliance.

Let Versalus Health Help You

Versalus Health, dedicated to the success of our clients in all areas of the clinical revenue cycle, supports hospitals and health systems by analyzing data thoroughly and providing insights from clinical and financial data. Versalus Health uses data analytics to hone in on revenue integrity and compliance areas that require the most attention. Versalus Health fixes those issues first, then works with you to strengthen all aspects of your clinical revenue cycle utilization management. The result is efficient utilization management, improved revenue integrity, and reduced compliance risk.

Contact us today to learn more about our services or to book a strategy call.


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Physician Advisors

Physician Advisors

Today’s hospitals and health systems require physician clinical expertise tied to in-depth knowledge of documentation best practices, length of stay management, quality, contracting, billing, and compliance, among other disciplines. Hospitals and health systems have invested significantly in building internal Physician Advisor teams to address these needs.