A SunHawk expert was hired to serve as interim Chief Compliance Officer for a non-profit regional health system, tasked with leading the IA and compliance departments. Responsibilities included assessing the HIPAA privacy and security program and supporting the search process for a permanent CCO. SunHawk's expert chaired the Compliance Committee, reported regularly to the CEO and Board Audit and Compliance Committee, providing updates on her work with senior leadership to improve RAC and third-party audit tracking, reviews, and responses. She also provided HIM training and support, evaluated the effectiveness of the enterprise’s compliance program for the Board, conducted compliance and privacy investigations, and worked with senior leadership to implement corrective action plans and monitoring. SunHawk's expertise and leadership were critical to the success of the organization during this transitional period, and her contributions were highly valued by the CEO and Board.

A large multi-practice dental organization engaged SunHawk to perform a random sample review of claims on a quarterly basis, ensuring that documentation and billing met requirements. Based on SunHawk's review, we provided recommendations for internal practice and medical documentation, aiming to clearly substantiate that procedures were performed. Over the year-long project, the practice group initiated several small yet significant changes, which led to a decrease in the frequency of coding errors and improvements in clear, supportive documentation.

An international neuroscience company engaged SunHawk to fulfill the requirements of a U.S.-based federal transparency law overseen by the Centers for Medicare & Medicaid Services (CMS), commonly known as the Sunshine Act or Open Payments. With the CMS reporting deadline quickly approaching, SunHawk successfully completed a comprehensive current-state assessment and provided a right-sized solution. SunHawk also supported the company with expert advice on the legislative complexities and nuances of the act, along with practical tips for achieving compliance. Consequently, the company was able to submit its first report ahead of the deadline and was well-positioned to maintain compliance with the act moving forward.

SunHawk partnered with a large, multi-faceted behavioral health organization to evaluate their current procedures, documentation, and coding as they sought a new electronic health record (EHR) system. Through staff interviews, site visits, and facility tours, SunHawk identified limitations of the existing EHR system and understood the process flow from patient intake to discharge. They distinguished necessary tasks from desirable ones in a new EHR system, which helped to eliminate or reduce the current limitations. This led to a tailored requirement list for a new EHR system, which the entity presented to prospective vendors for a customized solution.

SunHawk was engaged by one of the nation’s largest utilization management vendors to prepare policies, procedures, and reporting templates designed to ensure proper Medical Loss Ratio reporting for Commercial, Medicare Advantage and States’ Medicaid programs, including testing of quality improvement initiative expenses.

SunHawk reviewed multi-hospital inpatient claims regarding severe protein-calorie malnutrition (PCM) diagnoses, ensuring compliance with American Society for Parenteral and Enteral Nutrition (ASPEN) criteria, and physician documentation. SunHawk's review, including coding team queries, reported on documentation quality and conflicts. Based on the findings, the hospital system re-educated providers including nutritionists and dieticians of the ASPEN criteria and documentation requirements for this diagnosis. SunHawk also suggested the hospital system develop a compliant-query template to be used for all queries related to this diagnosis.

SunHawk helped a health management company optimize their Risk Adjustment (RA) coding processes. They clarified ambiguous areas of diagnosis coding and defined risk levels suitable for the company's RA program. SunHawk's review and recommendations refined the company's policies and procedures aligning them with their mission, values, and risk level. This resulted in the development of clear policies, a comprehensive RA coding education program, and a quality assurance initiative for RA coding.

SunHawk Consulting was entrusted by a multi-state population health management company to carry out a comprehensive audit of documentation for telehealth visits. This audit was necessitated as part of the strategic acquisition of a California-based health plan that was utilizing telehealth services for its members. Throughout the auditing process, SunHawk employed its expertise to unearth critical insights and identify necessary modifications to the existing documentation templates as clinical documentation improvements to ensure documentation supported all requirements of a telehealth visit.

SunHawk Consulting was hired by a multi-state population health management to carry out a comprehensive audit of medical record documentation of encounters which had been billed as a Medicare Annual Wellness Visit (AWV). This audit was necessitated as part of the strategic acquisition of a California-based health plan that was utilizing telehealth services for the AWV for its members. SunHawk identified missing and/or inadequate documentation, calculated the resulting Medicare overpayment, and formulated a comprehensive list of proposed changes for provider education and the existing documentation templates for clinical documentation improvement purposes.