Audits, Appeals & Legal Assistance
Four Seasons Consulting Group has the level of expertise to provide assistance with Additional Developmental Requests (ADRs) up to full legal reviews with expert testimony on cases involving the Department of Justice. Examining risk areas to help mitigate audits around eligibility issues and technical denials is a competency our team is equipped to handle.
· Independent chart reviews
· Identify risk areas of concern
· Mentor proactive improvements to processes related to key risk areas
· Education to leadership and staff
· Develop process for responding to ADRs
· Assistance with improving processes in response to audits
· Assistance with the appeals process
· Physician representation at ALJ and MIC Audit
· Legal reviews (for MIC, ZPIC, DOJ cases)
· Physician and expert testimony
Audits, Appeals & Legal Assistance Team
FSCG under the leadership of Janet Bull, contracts with over 12 qualified physician and nurse reviewers across the country to provide legal reviews to a host of programs across the country. Other key personnel in this area include our compliance team, led by Melody King.
Melody King, MSJ
Melody serves as the Compliance Manager and HIPAA Officer at Four Seasons. She graduated from Seton Hall University School of Law with a Master of Jurisprudence in Health and Hospital Law. Melody has a background in lab compliance and health education, and has immersed herself in healthcare privacy law, hospice regulations, audit response, and contract law. Melody has a clear passion for educating teams and fostering a culture of compliance across all facets of an organization. “Compliance is so much more than simply following the rules. It is the pursuit of excellence. It is the way we demonstrate our commitment to patient privacy and autonomy. It is the careful steps we take to ensure that each patient is getting the right care at the right time. And it is measurable – in the ways that we document our care, and in the ways that we collaborate with members of the team, the family, and the community that we serve. A healthy compliance program will not only protect the organization; it becomes part of the organization’s identity. This is an important way we can differentiate ourselves from our competitors.”