We bridge the gap between regulatory complexity and modern execution — at every level of your organization.
Most reporting teams are under-resourced for the complexity they face. We provide the expert capacity, proven methodology, and modern tooling to close that gap — whether you need hands-on filing support, strategic guidance, or a team that can build what your current tools cannot. Our work is practical, precise, and built for the real regulatory environment your organization operates in.
Six Service Areas Built for Healthcare Reporting
MLR Compliance & Filing Support
End-to-end support for medical loss ratio calculations, data validation, CMS submission, and audit-ready documentation. We work directly with your actuarial and finance teams to ensure every component of your MLR filing meets regulatory standards — and can withstand scrutiny.
Health plans and insurance carriers subject to ACA MLR requirements, particularly those with multi-state operations, complex creditable coverage populations, or prior audit findings.
Medicaid Managed Care Regulatory Reporting
Comprehensive guidance on encounter data submission, managed care reporting requirements, CHIP compliance, and state-specific regulatory obligations. We help MCOs navigate the full complexity of Medicaid reporting across CMS and state agency requirements.
Medicaid managed care organizations, CHIP plans, and integrated care entities managing complex reporting obligations across multiple state contracts.
Cost Report Preparation & Review
Rigorous preparation and independent review of Medicare and Medicaid cost reports, including hospital cost reports, SNF reports, and health plan cost reporting obligations. We ensure accurate cost allocations, proper statistical bases, and defensible methodologies.
Hospitals, skilled nursing facilities, health plans, and provider-sponsored organizations filing Medicare or Medicaid cost reports — especially those with complex structures or recent ownership changes.
AI & Automation Implementation for Reporting Teams
Safe, compliance-conscious deployment of AI tools and automation for healthcare reporting workflows. We help teams move beyond spreadsheets without introducing regulatory risk — building validated tools for MLR calculation, encounter data QA, SQL-based reporting, and more.
Reporting and compliance teams looking to modernize operations, reduce manual workload, and leverage AI without the risk of implementing unvalidated tools in regulated contexts.
Training & Staff Development
Structured training programs designed for healthcare reporting professionals at every level — from onboarding new analysts to building executive literacy around regulatory requirements and AI. Programs are custom-built around your actual reporting portfolio and team gaps.
Organizations onboarding new reporting staff, teams transitioning to new systems or methodologies, and executives who need working knowledge of MLR, Medicaid, and cost reporting to lead effectively.
Audit Readiness & Remediation
Pre-audit assessments, gap identification, documentation remediation, and representation support for CMS desk reviews, RAC audits, state regulatory examinations, and internal compliance reviews. We find the problems before auditors do — and fix them.
Organizations facing scheduled or anticipated CMS audits, state contract reviews, or internal compliance assessments. Particularly valuable for plans with prior findings or recent operational changes.
Schedule a Discovery Call
Select a time below for a 30-minute introductory call with Marcus Sterling to discuss your regulatory reporting obligations and how we can support you.