For Providers

For Providers

Drawing on our vast knowledge in a range of healthcare reimbursement, regulatory, and compliance subjects, Capra Health provides complete consulting support for hospitals, health systems, high-volume provider groups, long-term care providers, community health centers and more, including:

Health reform implementation.  “Obamacare”. Supreme Court challenges. Insurance exchanges and reforms.  State health reform.

As the Federal government and state legislatures struggle with an unsustainable healthcare delivery model, regulators are attempting to rein in costs through healthcare reform.  Unfortunately, the thrust of most of these policies involves reducing provider reimbursement while significantly adding to the burden of regulatory compliance for facilities/physicians and increasing patient cost-share.  As 2014 approaches and major insurance market reforms are set to be implemented, providers are tasked with rapidly understanding and developing compliant solutions to a complex web of quickly-evolving regulatory requirements.

Capra Health not only assists providers in their understanding of the applicable Federal health reform issues, but helps providers process how states like Louisiana and Georgia have developed strong legislative responses to that reform that greatly affect provider practice.  Beyond theory, Capra Health helps providers/facilities build comprehensive, but economical, business and compliance plans to address health reform requirements while helping providers develop and prioritize compliance and business solutions in the face of shrinking reimbursement and already-strained resources.

Managed care reimbursement.  Managed Medicaid implementation.  Medicare Administrative Contractor (MAC) transitions.  Accountable Care Organizations (ACOs). 

The major characteristic that all successful and solvent healthcare providers share is the existence of a comprehensive and resourced reimbursement program.  In order to be successful, providers/facilities require a commitment from the Executive Suite to capture revenue lost through compliant interactions with not only private insurers, but also government managed care and entitlement programs (including, but not limited to, Medicare, PBSI, Novitas, Cahaba, Medicaid, BAYOU HEALTH, PeachCare).

Whether it is Louisiana, where the State is currently undergoing the confusing transition from a single-payer Medicaid system to managed Medicaid, or a state like Georgia where that transition is more mature – providers/facilities have to understand complex regulatory, compliance and communication issues with all payers in order to secure appropriate reimbursement.

Capra Health can help providers build the appropriate internal framework and train/outsource a provider’s reimbursement staff in order to meet those vital reimbursement needs.

Medicare RAC Audits, Medicare RAC Appeals, Medicare PSC Audits, Medicare ZPIC Audits, Medicaid Integrity Contractor Audits (MIC audits), Audit Defense

Are you prepared?  While some providers have managed to get by so far without being affected by the armada of new healthcare audit mechanisms, health reform and tightening budgets nearly guarantee that you will be soon.

While many providers worry about the worst case through an audit defense strategy, we understand that there is no defense like a proactive compliance program.  Capra Health works with providers up front to ensure that your business is prepared when those auditors walk through your door.

While Capra Health’s audit defense consulting services are second to none, we prefer to work closely with you and your attorneys throughout all stages of the audit cycle – from preparation to clinical documentation and appeals – in order to help alleviate the financial and resource stress imposed by payor audits.

HIPAA.  HITECH.  EMTALA.  Kickback.  Stark.  QIO.  ERx.  Etc.

On top of all of the new reimbursement and compliance challenges imposed by health reform in a tightening marketplace, providers still have to deal with the confusing “alphabet soup” of daily healthcare regulations – both old and new.

Through its considerable and focused history of regulatory and legislative consulting, Capra Health helps providers in Louisiana, Georgia, and across the country understand which regulations are important and how different regulations fit together to help providers determine prioritization and applicability their short and long-term business objectives.

Please do not hesitate to contact Capra Health with any reimbursement, regulatory or compliance issue at  We are very happy to provide you with a consultation and our capabilities at any time!