Clinical due diligence is the process of assessing the clinical documentation and billing practices of a home health, hospice, or behavioral health organization. It is an important part of the due diligence process for any organization considering acquiring or investing in a healthcare company.
The goal of clinical due diligence is to identify any potential risks or areas of concern within the organization's clinical and operational practices. This includes assessing the quality of the clinical documentation, the accuracy of the billing, and human resource practices for compliance with federal, state, and payer requirements. These tasks can seem daunting, so here’s what you need to know:
Why is Clinical Due Diligence Important?
Clinical due diligence is important for a number of reasons. Here are the four main reasons you need to master all things clinical due diligence:
- Identifying Potential Risks – Clinical due diligence can help your agency or organization identify potential risks or areas of concern with the agency's clinical practices. Potential risks may include errors in the clinical documentation and/or billing process that could indicate potential overpayments or could impact the current and/or future census and revenue stream. Discovering this information can help you make an informed decision about whether to acquire or invest in the organization.
- Ensuring High-Quality Care – Clinical due diligence can help you ensure that the organization is providing high-quality care to its patients. Home health, hospice, and behavioral health agencies provide essential services to some of the most vulnerable members of our society. You want to make sure you’re investing in a place that meets the highest quality standards.
- Identifying Potential Compliance Issues - Clinical due diligence can help you identify any potential compliance issues with the agency or organization. This is important because healthcare organizations are subject to a variety of regulatory requirements. Failure to comply with these requirements can result in significant fines and penalties.
- Identifying Opportunities - Perhaps there is a problem retaining staff. Maybe it’s a faulty IT system. Doing your clinical due diligence will spot these issues. EHR tech is changing post-acute and behavioral health organizations and making huge impacts.
Taking the time to address clinical due diligence upfront can ensure you make the right decision for your business.
3 Key Areas of Focus for Clinical Due Diligence
There are three key areas of focus for clinical due diligence in home health, hospice, and behavioral health.
- Clinical documentation: This includes patient assessments, care plans, progress notes, and discharge summaries. The clinical documentation should be accurate, complete, and timely. It should also be compliant with all regulatory requirements. Take a hard look at your documentation.
- Billing: The agency's billing practices should be accurate and compliant with all regulatory requirements, and the agency or organization should be able to clearly justify the services it bills for. Have they optimized their EMR? Do they know how to track key performance metrics? Is their reporting concise?
- Compliance: The organization should be following all applicable regulatory requirements. This includes requirements related to patient safety, quality of care, human resources, and financial management. Are they up to date with survey readiness? Pre-bill audits? ADRs?
How Can You Conduct Clinical Due Diligence?
There are several ways to conduct clinical due diligence. One way is to hire a healthcare consulting firm that specializes in clinical due diligence. You need a consulting agency that has the experience and expertise in your specific industry to help you identify any potential risks or areas of concern with the organization’s clinical practices. Do you even know how much your agency is worth? Do you know your competitors and your market opportunities? You may need a market analysis.
Another way to conduct clinical due diligence is to do it yourself. However, this can be a time-consuming and complex process. If you choose to do it yourself, you will need to gather a significant amount of information, including the agency's clinical documentation, billing records, and regulatory compliance history. Just remember - you have no room for error.
Why Choose SimiTree for Clinical Due Diligence?
SimiTree is a leading provider of clinical due diligence services for home health, hospice, and behavioral health organizations. We have a team of experienced professionals who can help you assess the clinical documentation and billing progress of your organization. If your tech a due for a tune-up, consider learning more about our Healthcare IT Assessment.
Our team of experts can integrate seamlessly with your team to review clinical documentation, compliance incentives, corrective plans, reporting programs, oversight procedures, the organization’s response to adverse events, and other risk indicators, carefully assessing and constructing a complete picture of clinical compliance risk. Read more about clinical compliance risk assessment.
Unlike many consulting agencies, SimiTree understands the unique challenges of the home health, hospice, and behavioral health industries, and we have the expertise to help you identify any potential risks or areas of concern. We can also help you ensure that the organization is providing high-quality care to its patients and that it is compliant with all regulatory requirements.
Our services surrounding clinical due diligence include:
If you are considering acquiring or investing in a home health, hospice, or behavioral health organization, or just need advice on best practices, contact SimiTree today to learn more about how we can help you. We will be happy to answer your questions with a free consultation.
Visit our website at www.simitreehc.com or call us at 866.839.5471.