What We Do

Health Facility Surveys (Inspections)

HMS conducts Medical Facility Surveys (inspections) to assess the quality and safety of healthcare provided to patients and residents in our nation’s healthcare facilities (e.g., nursing homes, hospitals) as well as in outpatient treatment (e.g., dialysis centers, home health agencies). Before facilities/providers are permitted to accept Medicare and Medicaid patients/residents and bill for services under these federal programs, they must first be certified via an onsite survey/inspection and then periodically recertified to continue providing care and treatment and billing Medicare and/or Medicaid. Critically, the Centers for Medicare and Medicaid Services oversees the quality and safety of the provision of services in these certified facilities and HMS is honored and privileged to support their efforts.

Through onsite surveys, HMS’ highly trained clinicians and generalists conduct observations, interviews and record reviews of the care provided to patients/residents and of the environment in which that care is provided. Observations and interviews are conducted of patients/residents, staff, family, and others. Record reviews include inspection of written materials such as medical records, patient/resident/family complaints, facility policies and procedures, data, and more.

Medicare certification surveys are comprised of two components: a Health and Safety component and a Life Safety Component. Health and Safety Surveys evaluate the medical care provided to patients/residents while Life Safety Code Surveys evaluate the physical environment in which that care is provided.

Outside of the required certification surveys, complaint surveys can also be initiated for Health and Safety concerns and/or Life Safety Code Concerns. Complaint investigations are a very important tool to follow up on specific concerns related to a facility’s safety.  Examples of these types of concerns can include accusations of resident abuse, medication administration errors, dietary treatment plans not being followed, or malfunctioning fire alarms. All these examples of unsafe conditions can be reported for an onsite complaint investigation.

In addition to the overall safety of the provision of services, a very important aspect of the survey process is determining whether patients are afforded a clear set of patients’ rights and are treated with dignity and respect no matter the state of their physical or mental health.

Areas of Health and Safety evaluated during the Survey Process include, but are not limited to:

  • Patients/Residents Rights

  • Infection Control

  • Medication Administration

  • Medical Record Review

  • Accreditation Validation Process

  • Dementia Care

  • Vaccines

  • Emergency Medical Treatment and Labor Act (EMTALA)

  • Transitions of Care

  • Minimum Data Set (MDS) Assessment

  • Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID)

Areas of Life Safety Code evaluated during the Survey Process include, but are not limited to:

  • Physical Environment,

  • Health Care Facilities Code (HCFC),

  • Emergency Preparedness

Health Insurance Marketplace Compliance and Payment Model Support

HMS helps the Centers for Consumer and Insurance Information (CCIIO) ensure consumers maintain access to affordable, quality health coverage through enforcement of health insurance standards.

  • HMS conducts remote and onsite compliance reviews of Qualified Health Plans (QHPs) offered on the Federally Facilitated Exchange for compliance with Health Insurance Issuer Standards under the Affordable Care Act across business functions such as network adequacy, critical notices, guaranteed renewability, and agent and broker compliance reviews.

  • HMS personnel with expertise in healthcare compliance, health plan and provider operations, fraud, waste, and abuse, as well as nursing and claims administration, review QHP and Stand-Alone Dental Plan (SADP) operational documentation to evaluate compliance with standards related to complaint handling, meaningful access to health plan information, compliance with consumer notification requirements, and maintenance of appropriate access to providers and formulary medications, among other areas.

  • HMS conducts research within the healthcare and insurance industries and maintains a repository of Federal marketplace requirements which our project Subject Matter Experts and Protocol Team updates annually and as new guidance is issued.

  • Additional studies are designed and performed on the reliability and accuracy of machine-readable provider directory and formulary datasets.

Medical Record Review

HMS specializes in comprehensive medical record reviews to ensure the accuracy and integrity of data submitted to government agencies and private medical registries. Our expert team employs advanced medical record review methodologies, robust records management systems, meticulous data collection processes, and cutting-edge application development to conduct thorough audits. We efficiently serve both federal agencies and private organizations, providing reliable validation and compliance assurance.

These outcomes demonstrate the significant impact that thorough medical record reviews can have on various aspects of healthcare:

  • Improved Patient Care: Identifying incomplete or inaccurate documentation helps providers improve care quality, leading to better diagnoses and treatment plans.

  • Enhanced Compliance: Our audits ensure compliance with regulations, avoiding legal issues and maintaining institutional integrity.

  • Data Accuracy: Accurate data collection improves the reliability of health statistics and research, aiding public health policies.

  • Patient Empowerment: Ensuring patients have access to complete records empowers them in their healthcare, increasing satisfaction and outcomes.

Information Technology Solutions

HMS creates innovative, cost-effective solutions for federal and state agencies, blending clinical and IT expertise to support healthcare delivery.  Our aim is to enhance the efficiency and effectiveness of healthcare processes through comprehensive IT services that include software development and deployment, improving process workflows, and providing comprehensive data analysis and reporting.

  • Software Development: HMS develops tailored software solutions using current languages, frameworks, and process methodologies.  Our approach is grounded in human-centered design, ensuring ease of use while prioritizing low-code/no-code deployments that meet the specific needs of agencies.  DevOps practices are used, including continuous Integration/continuous delivery (CI/CD), to improve upon the quality and reliability of software delivered with a focus on enhanced security. 

  • Cloud Services and Integration: HMS supports a comprehensive stack of platforms and cloud services including SharePoint, Amazon Web Services (AWS), Azure, and Microsoft Power Platform.  Leveraging application programming interface (API’s), custom code, and cloud integration services, HMS offers systems integration with on-premise or cloud infrastructures.

  • Data Services and Emerging Technologies: HMS offers a comprehensive suite of data collection, analytics, modeling, and reporting services aimed at helping agencies understand their data for informed decision making.  Data integration tools are used to facilitate extract, transform, and load (ETL) processes for data analysis, visualization, and reporting through BI tools such as Tableau and Power BI.  Looking ahead, HMS monitors emerging technologies to enhance our services through business process automation, AI-driven data analytics, cyber security, and machine learning.

  • Security: HMS is committed to employing the most secure processes and procedures to protect our systems and data. Our dedicated team works tirelessly to stay ahead of emerging security threats and continuously updates our security measures to ensure the highest level of protection. Your trust is our priority, and we strive to maintain a secure environment for all our stakeholders.

  • Process Consulting and Support Services: HMS helps agencies streamline and optimize their workflows and processes by identifying areas for improvement while recommending appropriate solutions and strategies. Our team provides a wide range of technical support services including 508 compliance reviews, transcription services, and webinar hosting.  HMS also offers a suite of digital media resources including video editing and production, graphic development, social media marketing, and interactive training and tutorials.

Matthew (Matt) Loss - Director of Business Development

Matt serves as the Business Development Director, where he leads strategic initiatives to drive growth and expand the company’s presence in federal and state markets. With over 20 years of experience in business development and capture management, Matt brings a deep understanding of government contracting, healthcare, and IT solutions.

In his role, Matt oversees the Business Development team and collaborates closely with executive leadership to identify new opportunities, build strong client relationships, and position the company for long-term success. He also serves as the pricing lead by developing proposed project budgets and corresponding business volumes. Matt is known for his strategic insight, creative problem-solving, and ability to navigate complex regulatory environments. He is passionate about delivering innovative solutions that meet client needs while advancing the company’s mission.

Matt holds bachelor’s and master’s degree in business administration and is recognized for his commitment to excellence, inclusivity, and sustainable growth. Previous positions held include Proposal Manager, Contract Manager, and Program Director.