Healthcare business advisors Miami
We’re a Miami healthcare consulting firm and a strategic partner to the practices we serve. A Florida practice answers to Medicare, Florida Medicaid, its commercial plans and at least four regulators. You take care of patients; we build the foundation a new practice needs and help established ones run better, stay compliant and grow.
How we help
Medical credentialing services for practices in Florida and nationwide: commercial plans, Medicare, Medicaid, CAQH, contracting, recredentialing.
Learn moreHealthcare compliance consulting for practices: OIG's seven elements, policies, risk assessments, mock surveys, corrective action plans and training.
Learn moreHealthcare consulting services for medical and behavioral health practices: one-on-one advisors, operations, fractional COO and growth.
Learn moreHealthcare recruiters for medical and behavioral health practices: we find and screen candidates, and you hire them onto your own payroll.
Learn moreAHCA license or exemption in Florida: who s. 400.9905 exempts, Certificates of Exemption, PIP billing, fees, deadlines and inspections.
Learn moreMedical practice startup consultant for Florida: the filings in order, from entity and licenses to AHCA, local tax receipts, CLIA, DEA and credentialing.
Learn moreBeyond consulting
“We don’t just advise organizations. We help build the future of healthcare.”
Most practices call us about one urgent problem. We solve it first. After that, the same team can stay with you for compliance, operations, hiring and growth, because by then we know how your practice works.
Who we work with
When a matter needs a licensed professional, such as an attorney or an accountant, we coordinate with yours.
What can’t wait?
Pick the problem on your desk right now. Here is what we would do first.
What we would do first
Providers are waiting to join insurance networks
We list every provider, tax ID and plan, make sure each NPI record and CAQH profile is complete and attested, then file with Medicare, Florida Medicaid and each commercial plan. We follow every application to a signed agreement and an effective date, and we file early, because Medicare pays at most 30 days back from that date.
What we would do first
A survey or inspection is coming
Most Joint Commission surveys are unannounced, so we prepare you as if yours were tomorrow: a mock survey against the standard you will be judged on, staff ready for the questions surveyors ask, and a corrective action plan for anything it finds, done before the real one.
What we would do first
A payer is asking for records
Missing or insufficient documentation was behind 65% of Medicare’s fee-for-service improper payments in fiscal year 2025. We check the records the payer asked for against its rules before they go out, then audit a sample of your charts and claims and help you close the gaps before the next request.
What we would do first
We are opening a new practice
A new practice has 13 filings that wait on one another. We put them in the right order, from your entity and licenses to AHCA and local tax receipts, and start insurance credentialing early: Medicare’s effective date is never earlier than the day you file.
What we would do first
We need to hire providers or staff
No federal health care program pays for care from an excluded person, so our checks come before your offer. We write the job description with you, find and screen candidates, and verify each license and the federal exclusion list before you meet anyone. The person you choose joins your own payroll.
Who regulates what
Medicare’s contractor, Florida Medicaid (AHCA and its plans) and commercial insurers pay claims; OIG, OCR, AHCA and the Department of Health’s boards enforce the rules. A practice can be current with every payer and still be out of step with a regulator.
“The Agency for Health Care Administration is designated as the single state agency authorized to make payments for medical assistance and related services under Title XIX of the Social Security Act.”
| Agency | What it controls for your practice | Official page |
|---|---|---|
| AHCAAgency for Health Care Administration | Licenses, inspects and enforces the rules for health care facilities, including clinic licenses and exemptions; investigates complaints about facilities and managed care plans; certifies HMOs. | Bureau of Field Operations |
| Florida MedicaidRun by AHCA | Pays for Medicaid services, only to qualified providers; enrolls providers and renews their enrollment; contracts the Statewide Medicaid Managed Care (SMMC) plans, each of which credentials you separately. | Provider enrollment |
| DOHDepartment of Health and its boards | Licenses and disciplines practitioners in more than 40 professions, from medicine and nursing to mental health counseling; holds each licensee’s address of record; receives adverse-incident reports from physicians’ offices. | FL HealthSource |
| DCFDepartment of Children and Families | Licenses substance abuse service providers (chapter 397); operating without a license or exemption is a third-degree felony. Also decides who is eligible for Medicaid. | Substance use licensing |
| CMS and First CoastMedicare and its Florida contractor (Jurisdiction N) | Medicare enrollment (PECOS), claims and payment, first-level appeals, local coverage determinations and review of selected claims. | Jurisdiction N |
| OIGHHS Office of Inspector General | Excludes individuals and organizations from federal health care programs; hiring an excluded person can bring civil money penalties. | Exclusions Program |
| OCRHHS Office for Civil Rights | Enforces the HIPAA Privacy, Security and Breach Notification Rules, 42 CFR Part 2 (anyone may file a complaint since Feb 16, 2026) and civil rights laws such as Section 1557’s language-access rule. | About OCR |
Sources: Florida Statutes ss. 20.42, 400.991, 400.9905, 409.902, 20.43, 456.035, 397.401 and 20.19 (2026); CMS, What’s a MAC; HHS, Understanding Part 2 and 45 CFR 92.201. Read Oct 17 and 19, 2026.
Sources: Florida Statutes ss. 458.351 and 408.810; 42 CFR 424.516 and 401.305; 42 U.S.C. 1320a-7k(d); 45 CFR 164.524 and 164.404. Read Oct 17 and 19, 2026.
Miami English & Español
Consultoría de negocios en salud en Miami, en inglés y en español.
Our office is in The Hammocks, in southwest Miami-Dade. We work with practices across the United States, and our team works in English and Spanish, with you and with your staff.
Plain-English guides
Credentialing, compliance and opening a practice, explained by the team that does the work.
Guide
Credentialing, enrollment and contracting are three different steps. What each one means, what plans ask for and how long they say it takes.
Guide
Entity, licenses, AHCA, enrollment and insurance, in the order they have to happen.
Checklist
The policies, safeguards, agreements and training a small practice needs, item by item.
Short answers
The Bureau of Labor Statistics counts management consultants as management analysts, some focused on healthcare; they interview staff, analyze data and develop solutions.
Meeting the rules the agencies above enforce, on their deadlines, plus routine checks such as screening staff against OIG’s monthly exclusion list.
Payment rides on it. Excluded people “can receive no payment” from federal health care programs, and by Oct 31, 2024, OCR had settled or fined 152 HIPAA cases for $144,878,972.
Medicare targets 95% of clean initial online applications in 15 days and all in 50, or all in 85 when a site visit, a request for more information or fingerprints are needed. Florida Medicaid says “60 Days or Less.”
Nearly every plan asks for a license, DEA registration, board certification status, work history, malpractice face sheet, W-9, NPI and a CAQH profile it can view.
Talk to an advisor
Tell us where your practice is today. We will tell you what we would do first.
