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Edelberg & Associates: Using Informatics to Reduce Healthcare Compliance Risks

 Caral Edelberg, CEO
The challenges faced by corporate CIOs have grown considerably due to the demands imposed by electronic medical records used to support medical billing. Challenges relating to data theft and privacy laws daunt administrators and providers. In order to assure compliance with governmental regulations designed to prevent data theft as well as fraud and abuse, informatics must assess compliance with complex billing policies that may vary from one payer to the next.

There is an overwhelming sense that security and preventing data breaches is a top priority for companies managing Healthcare compliance. There have been millions of patient health records breached since the inception of HIPAA. Breaches can result in costly fines for hospitals and health providers, so proactively protecting against data breaches is a top priority for CIOs. Edelberg & Associates has made security a top priority for all our systems in order to ease these concerns for CIOs while working with providers to improve the documentation in the records to meet federal guidelines and protect against billing errors.

Edelberg’s firm, headquartered in Dacula, GA, provides medical coding, compliance and informatics with a key focus on reducing risk and increasing the enterprise value of healthcare providers. “Our primary purpose is to proactively protect the institution from compliance problems,” says Caral Edelberg, CEO and owner of Edelberg & Associates. Initially founded as a coding and compliance vendor, Edelberg & Associates now has gradually evolved into providing state of the art informatics, for facilities with a focus on identifying compliance problems that require additional provider education to avoid.

As a thought leader, Edelberg ensures that all federally required billing data are met and provides feedback to the organizations and clinicians when documentation must be improved to comply.
“We make sure that we protect our client’s revenue while keeping in mind the existing rules and regulations,” assures Edelberg. “We tailor our applications to the needs of the organization, as every hospital and medical specialty is unique in terms of its operational processes and technical intricacies,” adds Edelberg.

We make sure that we protect our client’s revenue while keeping in mind the existing rules and regulations


“Much of what we do,” says Edelberg, “is based on process improvement with an understanding of how to achieve compliance with existing regulations. The goal is to prevent problems rather than constantly solving them.” Edelberg’s compliance services identify best practices for organizations to support risk mitigation and provide greater visibility to the efficacy of medical coding operations.

One of the company’s clients, a large University Emergency Department, was facing the challenge of completing medical records in time for billing. “Through design and implementation of an immediate and dramatic process improvement, Edelberg & Associates was able to identify that over 15 percent of the records never reached the billing department,” says Edelberg. By tracking missing records, using informatics and working directly with physicians and nurses who were responsible for the missing or incomplete records, the hospital was able to achieve an increase in gross revenue in excess of $15,000,000.

Edelberg & Associates helps organizations better align their valuable information while ensuring knowledge is retained as systems evolve. Additionally, CIOs have many different systems they use in their facilities - the ability to seamlessly and securely connect those systems in order to reduce costs and increase the availability of data to all parties has become a high priority. In Edelberg’s solution, they have deep integration points into various systems (flowing both in and out) in order to facilitate these priorities. Edelberg expects this path to lead to greatly improved information coming from well-informed medical personnel that collaborate with billing and compliance systems to minimize errors, improve revenue and assure financial viability for the health systems they serve.