Bingham Health Care


 

Our Services

Bingham Health Care provides strategic and operational consultation and planning to healthcare payers and providers, and helps payers with filing and reporting requirements related to the Affordable Care Act (ACA).

A particular specialty of Bingham Health Care is to perform HIPAA audits for payers and providers, to assess compliance with HIPAA Administative Simplification (AS) provisions, including the Privacy Rule, Security Rule, and Breach Notification Rule, as amended by the HITECH Act.

We have worked with national, regional, state, and local payers, including well-known brands, start-ups, CO-OPs, and county health systems.

We offer the following services to address your organization's needs & goals:

  • HIPAA Audits
    • Assess provider / payer compliance with HIPAA
      • Administrative Simplification
      • Privacy Rule, Security Rule, Breach Notification Rule
      • HITECH Act
    • Provide independent evaluation
      • To complement internal compliance and HIPAA audits
    • Develop remediation plan
      • Working with management
      • Highlighting non-compliance
      • Addressing out-of-compliance areas
    • Assist in improving compliance
      • Work alongside staff and teams
      • For improvements to meet HIPAA requirements
    • Supply tangible results for internal and external use
      • Use with Board and investors
      • Use in marketing
      • Use if HHS OCR audits, to demonstrate active intent to comply with HIPAA
    • Perform re-audit
      • To validate remediation steps
      • To reassess potential areas still out-of-compliance
      • As preventive over time as company and regultions change
  • ACA Exchanges / Marketplaces
    • Planning
      • evaluate participation
      • participation preparation
    • Operation
      • begin participation
      • operating on an exchange
      • efficiencies/improvements/optimizations
    • Exit
      • analyze the decision
      • execute exchange exit
    • Other assistance
      • marketing, messaging, and brand image
      • member/consumer outreach, customer service, and public relations
      • organizational restructuring
      • vendor search and support
      • staff augmentation
  • Programs
    • QHP certification
    • 3 Rs: reinsurance, risk corridors, & risk adjustment
    • EDGE servers
    • IRS 6055/6056 (1094/1095)
    • mandated reporting
  • Plans, Networks, and Providers
    • benefit plan design
    • essential health benefits (EHBs)
    • cost-sharing reductions (CSRs)
    • network/plan types (PPO, EPO, HMO, POS, ACO, PCMH, etc.)
    • provider contracting and retention
    • rent-a-net
    • telehealth / Teladoc
    • specialty providers & service offerings
  • Regulations
    • provide overview and training to:
      • executive team
      • management
      • staff (department/function specific)
    • guided assistance with:
      • state regulators (DOI, DOBI, OCI, DMHC, etc.)
      • federal regulators (HHS, CMS, Treasury, IRS, etc.)
      • exchanges/marketplaces (federal, state, hybrid, private)
      • certifying organizations (NCQA, URAC, etc.)
    • case-specific review and recommendations
  • Private Exchanges
  • Small, Mid, Large, and Custom Group Markets (integrating with ACA business)
  • Medicare & Medicaid (as they relate to the ACA)
  • Custom consulting engagements and assistance

Our expertise extends to virtually all areas of the ACA, much of which Mr. Bingham discusses in an ACA whitepaper, authored while assisting another consulting practice.


Please contact us for help optimizing your business operations, and obtaining or maintaining a competitive advantage.

 

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Please contact us at info@binghamhealthcare.com with questions or to schedule a call.

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