● Our Primary goal with each Audit is to ensure every medical record is coded to the highest degree of specificity in accordance with all State and Federal Programs.
● Conduct a line-by-line- item review of every medical record and report any discrepancies or questions to the practice(s) for review and approval daily.
● Develop a history going back up to ten years is searched and documented for every patient.
● We ascertain that all encounters/claims submitted by the practice(s) to the Health Plan or CMS are accepted and processed correctly.
● We review the HCC conditions accepted and ensure the appropriate premium is being assigned to each member.
━━━━━━━━━━━
OUR SERVICES
At GSD Practice Management, we provide expert services to Primary Care Providers, Medicare Provider Groups, and Accountable Care Organizations (ACOs). Our solutions ensure compliance, accuracy, and optimized reimbursements to help healthcare providers thrive.
Medicare Advantage / Medicare Risk Adjustment
For Primary Care Providers, Medicare Provider Groups, and Accountable Care Organizations (ACO’s) and Health Plans
Medicare Advantage / Medical Billing
For Primary Care Providers, Medicare Provider Groups, and Accountable Care Organizations (ACO’s)
● Review that the Audit identified conditions are accurate on the encounters/claims prior to submission.
● Encounters/claims are submitted weekly for each practice (s) and identify conditions being treated not in the medical chart are identified.
● Develop addendums for the conditions being treated and not in the medical chart for provider approvals.
● Ascertain that all encounters/claims submitted by the practice(s) to the Health Plan or CMS are accepted and processed correctly.
● Conduct reviews for new members monthly, pull the plan Member Summaries to look for revenue reallocation cases and reconciliation against the MO-04's.
Medicare Advantage / Medicare Population Health Management
For Primary Care Providers, Medicare Provider Groups, and Accountable Care Organizations (ACO’s)
● Population Health Management Programs
● Comprehensive Annual Wellness Visits (AWVs)
● Risk Stratification Programs
● Social Determinants of Health (SDOH) Programs
● Transitions of Care (TOC) Initiatives to Reduce Readmissions
Chronic Care Management (CCM) for High-Risk Patients
● ER Avoidance with a Focus on Medium to Higher Acuity Patients
CMS Applications & Compliance
For Medicare Advantage Plans and all ACO Programs Primary Care Providers, Medicare Provider Groups and Hospital Systems
● Certificate of Authority Filings
● Medicare Advantage Applications
● ACO REACH and MSSP Applications
● Policies and Procedures Development
Physician Training Modules
● Transitions of Care Program
● Chronic Care Improvement Program
● ER Diversion Program
● Health Equity Plan (HEP) Program
● Medical Risk Adjustment Program
● Preventive Health Risk Management & HCC Capture Program
● Health Risk Assessment (HRA) & Annual Wellness (AWV) Encounter Program
Marketing for Primary Care Providers, Medicare Provider Groups
Ask us about capitated concierge commercial members with no risk.
● Digital Marketing Campaigns
● List Procurement
● Call Center Services
● Content Development Services
● MA Sales Support
━━━━━━━━━━━
STAYING AHEAD IN TODAY’S HEALTHCARE LANDSCAPE
The healthcare industry is evolving fast — will your practice keep up?
The healthcare industry is constantly evolving and forcing providers to stay up to date with the changes to survive. The changes include but are not limited to:
● Technology
● Clinical data and treatments
● Mandated preventive screening
● Billing and Coding
● Marketing
● Practice management
The winners and losers will be determined by those who can adapt to the realities of today's healthcare changes. Having a dynamic and effective team has become paramount for those providers who are working in this highly regulated environment.
WHY ARE MEDICAL PRACTICES/PLANS FAILING?
The most common reasons include:
Billing and Cash flow issues
Lack of Growth and Retention Plan
Failure to comply with Federal or local quality Guidelines
Improper coding and documentation
Overdependence on one source of revenue
OUR MISSION
"To help our partner clients achieve the professional and clinical success they deserve."
GET IN TOUCH WITH US TODAY!
Let us help you optimize your Medicare Advantage processes and compliance.
Email Us: diazgranadose@gsdhc.com | Office Address: 9551 Weldon Circle, #E414, Tamarac, FL 33321
© 2025 by GSD Practice Management. All Rights Reserved.
© 2025 by GSD Practice Management. All Rights Reserved.