Using CAAT in Compliance
|
|
|
- Jocelyn Baker
- 10 years ago
- Views:
Transcription
1 Using CAAT in Compliance Auditing Suzann Hall, CPA, ACDA November 12, 2010
2 CHAN Founded in 1997 through the collaboration of Ascension Health and Catholic Health Initiatives, the two largest not-for-profit Catholic healthcare systems in the US Employs more than 300 audit professionals who work in 36 states Implemented audit functions in 29 healthcare networks Current ongoing operations in close to 600 hospitals and other healthcare facilities nationwide
3 CHAN Advantages Facility based auditors (Client Based Associates, IT and Coding Compliance Auditors) on-site and interact with management creates a more fluid audit process where emerging risk can be assessed and addressed timely. CHAN Support: o CAAT Team o Coding and Compliance Audit Team o IT Audit Team o Knowledge Warehouse o Subject Matter Experts
4 CAAT Computer Aided Audit Techniques/Tools Wikipedia defines CAAT as: The practice of using computers to automate or simplify the audit process. CAATs can refer to any use of a computer during the audit. This would include utilizing basic software packages such as ACL, SAS, Excel, Access, Crystal Reports, Cognos, Business Objects and also word processors.
5 CAAT Traditionally, auditors used samples to reach conclusions regarding the effectiveness of controls against the whole population. With CAATs, auditors can analyze large volumes of data/entire population looking for anomalies. CAATs allow for specific risk based testing. CAATs can identify unexpected or unexplained patterns in data that may indicate fraud.
6 ACL Data analysis software for audit, compliance and risk professionals. o Developed for auditors. o Provides data mining abilities for specific risk based testing. o Provides a log of actions taken on the data to help ensure accurate testing and assumptions during the audit process. o Does not change the data.
7 Audits with CAATs CHAN audits with CAATS Revenue Charge Capture Bad Debt Historical Reviews RAC Audits Excluded Provider Reviews Accounts Payable/Payroll Charge Description Master Reviews Continuous Control Monitoring Technology Featured Services
8 Revenue Charge Capture Surgery o Surgery Time Charged? o Anesthesia Time Charged? o Recovery Room Charged? Emergency Room o ER Level visits charged? Inhalant Treatments o Patients with inhalant treatments were also charged with an inhalant drug? o Patients with an inhalant drug were also charged with an inhalant treatment?
9 Bad Debt Historical Reviews An analysis of historical transactions is used to provide the accuracy of an entity s past allowance calculations. In addition, it also provides: o Current estimations of its allowance for doubtful accounts. o Trending for changes in the environment.
10 RAC Audits Using some of the same criteria used by RAC Audit Contractors. CAAT provides the Coding and Compliance Auditors with populations of patients to review for overpayments and underpayments. o RAC Focused DRGs o Surgical Short Stays o Hospital Acquired Conditions
11 Other CAAT Audits Excluded Provider Reviews o Compares Vendors, Employees and Physician utilized to the OIG and GSA listing of excluded providers. Charge Description Master Review o Reviews hard coded CPT/HCPCS Codes to ensure they are current active codes defined by CMS. Interface Reviews o Compares transactions sent from one system to those accepted by another system for completeness and accuracy.
12 Continuous Control Monitoring Technology Continuous Control Monitoring Technology (CCMT) Moving beyond a static, cyclical audit approach and adopt a continuous, comprehensive approach to audit and risk assessment. Used by internal auditors to support continuous auditing. Used by management to support continuous monitoring. Optimizes the use of technology.
13 Featured Services Web-based Continuous Auditing/Monitoring Tools o AR Hindsight Review o Coding Compliance (RAC, MIC, etc.) Charge Capture Analysis Services o Emergency Department o Interventional Radiology o Surgery Implants
14 CHAN Contact Information Tom Tharp, CISA Sr. Director of Featured Services Suzann Hall, CPA, ACDA CAAT Manager
Georgia Physician Medical Record/Recovery Audit Contractors
Georgia Physician Medical Record/Recovery Audit Contractors Auditors Name/Purpose Legal Basis Review Process Record Request Limit/Time Period Audit Time Line Actions You Can Take Medicare RAC-Connolly
Continuous Auditing and Monitoring Leveraging Your Data for Compliance
Continuous Auditing and Monitoring Leveraging Your Data for Compliance A Phyllis Patrick & Associates LLC White Paper April 2014 Gail Hormats, B.S., M.B.A., C.I.A., C.I.S.A., C.R.M.A., C.A.D.A. Automated
Current Uses and Trends in ACL and Data Mining
Current Uses and Trends in ACL and Data Mining Weaver and Tidwell, L.L.P. January 10, 2013 Marlon B Williams, CPA, ACDA Partner, Assurance Reema Parappilly, CISA Senior Manager, IT Advisory Objective Discuss
MDaudit Compliance made easy. MDaudit software automates and streamlines the auditing process to improve productivity and reduce compliance risk.
MDaudit Compliance made easy MDaudit software automates and streamlines the auditing process to improve productivity and reduce compliance risk. MDaudit As healthcare compliance, auditing and coding professionals,
Auditing Application User Account Security and Identity Management with Data Analytics
Auditing Application User Account Security and Identity Management with Data Analytics James Kidwell, JD, CISA Senior Information Systems Auditor Audit Services Session Agenda and Learning Objectives Brief
Forensic Audit and Automated Oversight Federal Audit Executive Council September 24, 2009
Forensic Audit and Automated Oversight Federal Audit Executive Council September 24, 2009 Dr. Brett Baker, CPA, CISA Assistant Inspector General for Audit U.S. Department of Commerce OIG Overview Forensic
Medicare Recovery Audit Contractors
RAC Questions & Answers What is CMS s expansion schedule for the nationwide RAC program? Who will serve as contractors for the nationwide RAC program? Whose claims can be reviewed by the RAC? Aren t RACs
THE VALUE OF A COMPLETE CODING QUALITY AUDIT PROGRAM. By Lisa Marks, RHIT, CCS, Coding Audit Director, Precyse
THE VALUE OF A COMPLETE CODING QUALITY AUDIT PROGRAM By Lisa Marks, RHIT, CCS, Coding Audit Director, Precyse TRUE OR FALSE: One coding audit a year of a random sample of 30 charts per coder is sufficient
Transfer DRGs: Approaches to Revenue Recovery. A BESLER White Paper
Transfer DRGs: Approaches to Revenue Recovery A BESLER White Paper June 2014 Copyright 2014 BESLER Consulting. All rights reserved. *HFMA staff and volunteers determined that Transfer DRG Revenue Recovery
Leveraging Predictive Analytic and Artificial Intelligence Technology for Financial and Clinical Performance
Leveraging Predictive Analytic and Artificial Intelligence Technology for Financial and Clinical Performance Matt Seefeld CEO & Co-Founder [email protected] www.interpointpartners.com (404)446-0051
Revenue Cycle Management Practice
Revenue Cycle Management Practice W h i t e p a p e r By William Malm, ND, RN Practice Director, Revenue Cycle Management, HCPro, Inc. Recovery audit contractors Recovery Audit Contractors Strategic planning
CASE STUDY: St. Joseph Medical Center. Compliance 360 GRC Software Suite
CASE STUDY: St. Joseph Medical Center Compliance 360 GRC Software Suite 2 CASE STUDY: St. Joseph Medical Center Background Since June 1, 1887, when the doors opened at Houston s first hospital, St. Joseph
The Fraud and Abuse Environment for Anesthesiologists
The Fraud and Abuse Environment for Anesthesiologists Jointly Sponsored By: Anesthesia Business Consultants, LLC Tulane University School of Medicine Department of Anesthesiology The Center for Continuing
Implementing a New Technology: FPS Successes, Challenges, and Best Practices
Implementing a New Technology: FPS Successes, Challenges, and Best Practices Centers for Medicare & Medicaid Services Raymond Wedgeworth Director, Data Analytics and Control Group Center for Program Integrity
HCCA COMPLIANCE INSTITUTE. HCCA - AHIA Auditing & Monitoring Focus Group Progress Report
HCCA COMPLIANCE INSTITUTE New Orleans, LA Tuesday, April 19, 2005 Workshop from 3:00pm 4:00pm HCCA - AHIA Auditing & Monitoring Focus Group Progress Report Randall Brown, CIA Baylor Healthcare System Corporate
Information Integrity in the Revenue Cycle! Order Entry, All Subsystems and The Charge Description Master
Information Integrity in the Revenue Cycle! Order Entry, All Subsystems and The Charge Description Master 2011 Our Philosophy: We are a firm believer in information integrity. Therefore we perform on or
The Indiana Family and Social Services Administration
The Indiana Family and Social Services Administration Program Integrity (PI) Medicaid Advisory Committee Meeting December 11, 2014 Agenda Program Integrity A range of activities to address and eliminate
The Federal Railroad Retirement Board (RRB) and Data Analytics
Exploring Innovation Leads to Data Analytics Phase I February 14, 2013 OFFICE OF INSPECTOR GENERAL RAILROAD RETIREMENT BOARD INTRODUCTION In response to the Federal government s mandate to become more
Chargemaster Basics and Beyond
Chargemaster Basics and Beyond Marilyn Hart Niedzwiecki CPA, MBA, RN, CPC, CPC H Director Revenue Integrity Children's Memorial Hospital, Chicago, IL Children s Memorial Hospital Chicago 247 Bed Children
ACCOUNTS PAYABLE AUDIT RECOVERING LOST DOLLARS AT NO COST
ACCOUNTS PAYABLE AUDIT RECOVERING LOST DOLLARS AT NO COST 1 Our Objective To assist organizations in finding lost thousands of dollars in profits through duplicate payments, duplicate billings, overpayments,
Exploring the Impact of the RAC Program on Hospitals Nationwide. Results of AHA RACTRAC Survey, 4 th Quarter 2012
Exploring the Impact of the RAC Program on Hospitals Nationwide Results of AHA RACTRAC Survey, 4 th Quarter 2012 March 8, 2013 RAC 101 Centers for Medicare & Medicaid Services (CMS) Recovery Audit Contractors
MEDICARE RECOVERY AUDIT CONTRACTORS AND CMS S ACTIONS TO ADDRESS IMPROPER PAYMENTS, REFERRALS OF POTENTIAL FRAUD, AND PERFORMANCE
Department of Health and Human Services OFFICE OF INSPECTOR GENERAL MEDICARE RECOVERY AUDIT CONTRACTORS AND CMS S ACTIONS TO ADDRESS IMPROPER PAYMENTS, REFERRALS OF POTENTIAL FRAUD, AND PERFORMANCE Daniel
What Your Organization can do to Avoid the Risks. Jane Snecinski Post Acute Advisors, LLC P.O. Box 12078 Atlanta, GA 30355 www.postacuteadvisors.
What Your Organization can do to Avoid the Risks Jane Snecinski P.O. Box 12078 Atlanta, GA 30355 www.postacuteadvisors.com Any level of care that occurs after an acute care stay LTAC (Long Term Acute Care
HEALTH CARE AUDITING & MONITORING TOOLS
HEALTH CARE AUDITING & MONITORING TOOLS TABLE OF CONTENTS ABOUT THIS MANUAL SUGGESTIONS INTRODUCTION LIST OF CONTRIBUTORS MONITORING & AUDITING PRACTICES FOR EFFECTIVE COMPLIANCE PLANNING AND CONDUCTING
Protect and Improve Profitability in Your Practice. Positioning Your Organization for a RAC Audit
Protect and Improve Profitability in Your Practice Positioning Your Organization for a RAC Audit 2011 Annual Educational Seminar March 9, 2011 Presented By: Cindy Tipton-Cain, Exec. Director Physician
Indiana Recovery Audit Contractor (RAC) Complex Reviews Webinar February 15, 2013
Indiana Recovery Audit Contractor (RAC) Complex Reviews Webinar February 15, 2013 Webinar Goals Provide information HMS - selected vendor as the Indiana Medicaid RAC Indiana s Medicaid RAC Program Details
RAC Audits. RAC audits. RAC Audits 1/31/2014. What you need to know By Angie Cameron and Maggie Lester Johnston Barton Proctor & Rose
RAC Audits What you need to know By Angie Cameron and Maggie Lester Johnston Barton Proctor & Rose RAC audits In early January 2013, Medicaid rolled out its plan for Recovery Audit Contractor Reviews of
Continuous Auditing with Data Analytics
Continuous Auditing with Data Analytics Brooke Miller, CPA, CIA, CPCU [email protected] Sean Scranton, CPCU, CISSP, CISM, CISA [email protected] Overview Understand embedding data analytics
Division of Medical Assistance Program Integrity Unit
Division of Medical Assistance Program Integrity Unit Program Integrity Unit Federally mandated Prevent, identify, and investigate potential fraud, waste, and abuse within Medicaid Possible fraud is referred
Using Technology to Automate Fraud Detection Within Key Business Process Areas
Using Technology to Automate Fraud Detection Within Key Business Process Areas 2013 ACFE Canadian Fraud Conference September 10, 2013 John Verver, CA, CISA, CMA Vice President, Strategy ACL Services Ltd
Recovery Audit Contractor Program
Recovery Audit Contractor Program What is a RAC? Recovery Audit Contractor RAC Mission Detect and correct past improper payments so that future improper payments can be prevented: Providers can avoid submitting
How to Prepare a Winning RAC Appeal
How to Prepare a Winning RAC Appeal Craneware InSight Consulting Copyright 2011, CRANEWARE INSIGHT. All rights reserved. www.cranewareinsight.com p.1 Introduction Introductions Karen Bowden, RHIA, Senior
How to Successfully Appeal a RAC Audit. Kelly McCloskey Cherf Hogan Marren, Ltd.
How to Successfully Appeal a RAC Audit Kelly McCloskey Cherf Hogan Marren, Ltd. General Background RAC - Recovery Audit Contractor The Medicare Prescription Drug, Improvement, and Modernization Act (2003)
RAC Lessons Learned Medicare s s Recovery Audit Contractor (RAC) Program
New York - Presbyterian Hospital RAC Lessons Learned Medicare s s Recovery Audit Contractor (RAC) Program Presented by Karen M. Feeley New York - Presbyterian Hospital March 5 th, 2009 New York - Presbyterian
Tennessee Primary Care Association: 2014 Annual Leadership Conference
CPAs & ADVISORS experience momentum // SETTING YOUR ORGANIZATION UP FOR SUCCESS: UNDERSTANDING THE COMPLEXITIES OF THE FQHC REVENUE CYCLE Tennessee Primary Care Association: 2014 Annual Leadership Conference
Having Trouble Explaining and Predicting Net Revenue?
Having Trouble Explaining and Predicting Net Revenue? Crowe Revenue Cycle Analytics Audit Tax Advisory Risk Performance The Crowe Revenue Cycle Analytics Solution As shown below in use by hundreds of hospitals
Best Practices in Claims Management. Use of treatment guidelines and clinical logic for preauthorization and claims adjudication
Best Practices in Claims Management Use of treatment guidelines and clinical logic for preauthorization and claims adjudication The need for standards in claims processing Indian health insurance companies
Department of Health and Mental Hygiene Medical Care Programs Administration
Audit Report Department of Health and Mental Hygiene Medical Care Programs Administration December 2010 OFFICE OF LEGISLATIVE AUDITS DEPARTMENT OF LEGISLATIVE SERVICES MARYLAND GENERAL ASSEMBLY This report
and the Mechanics of MICHAEL K. HARRINGTON, MSHA, RHIA, CHP Faculty Department of Health Administration St. Joseph's College of Maine Standish, Maine
HEALTH CARE FINANCE and the Mechanics of Insurance and Reimbursement MICHAEL K. HARRINGTON, MSHA, RHIA, CHP Faculty Department of Health Administration St. Joseph's College of Maine Standish, Maine Ä-
ADMINISTRATIVE MANUAL Subject: CORPORATE RESPONSIBILITY 21.49. Directive #: 21.49 Present Date: January 2011
Page: 1 of 18 Directive #: 21.49 Present Date: January 2011 Original Date: September 2004 Review Date: January 2013 Applicable To: SVHC & Affiliated Companies SVMC SCLM SLH FCPC POLICY In furtherance of
Audit Management Solutions Overview. Wednesday, January 8, 2014 By Dawn Crump, MA, CHC, SSBB VP of Audit Management Solutions
Audit Management Solutions Overview Wednesday, January 8, 2014 By Dawn Crump, MA, CHC, SSBB VP of Audit Management Solutions Agenda Auditor Overview Audit Impact Importance of AudaPro to the Client Financial
Jane Snecinski, FACHE Post Acute Advisors, LLC P.O. Box 12078 Atlanta, GA 30355 www.postacuteadvisors.com
Jane Snecinski, FACHE P.O. Box 12078 Atlanta, GA 30355 www.postacuteadvisors.com RAC Demonstration Project 3 year demonstration project Greatest impact to IRF from California Issue with greatest impact
Introduction. Centralizing and simplifying your RAC processes is of the utmost importance so you can avoid the 10 most common RAC mistakes.
TOP 10 RAC Mistakes Introduction Constrained assets. Limited time. Sound familiar? These are problems encountered on a daily basis by many of us in the health care field. We are constantly tasked to find
empowersystemstm empowerhis Advanced Core Hospital Information System Technology Comprehensive Solutions for Facilities of Any Size
empowersystemstm empowerhis TM Advanced Core Hospital Information System Technology Comprehensive Solutions for Facilities of Any Size ADT / Patient Registration System + Fully Integrated Patient Registration
THE MEDICARE RECOVERY AUDIT CONTRACTOR (RAC) PROGRAM: An Evaluation of the 3-Year Demonstration
THE MEDICARE RECOVERY AUDIT CONTRACTOR (RAC) PROGRAM: An Evaluation of the 3-Year Demonstration June 2008 THE MEDICARE RECOVERY AUDIT CONTRACTOR (RAC) PROGRAM: An Evaluation of the 3-Year Demonstration
Interview Questions for Charge Capture audits
Interview Questions for Charge Capture audits What system(s) is(are) used for charge entry and documentation? Who enters orders into the system? Are any procedures performed without a written order? Or,
Risk Adjustment ABC s
Medicare Advantage Risk Adjustment and Coding Academy Coding Risk Adjustment Documentation Training Risk Adjustment ABC s What is Risk Adjustment? Risk adjustment is the process by which the Medicare &
Medicare s Recovery Audit Contractor (RAC) Program
Recovery Audit Contractor Update Medicare s Recovery Audit Contractor (RAC) Program HFMA Northern California Spring Conference Rudy Braccili Jr, MBA, CPAM Sr. Director, National Medicare & Medicaid Center
Predictive Analysis Risk Analysis
Predictive Analysis Risk Analysis MARYLAND ASSOCIATION OF CPAS GOVERNMENT AND NOT-FOR-PROFIT CONFERENCE April 25, 2014 Overview Forensic Audit and Automated Oversight Data Analytics for Grant Oversight
Revenue Cycle Responsibilities. Revenue Cycle. Objectives 4/9/2013
Revenue Cycle Kathryn DeVault, RHIA, CCS, CCS-P AHIMA 2013 Objectives Identify responsibilities within the Revenue Cycle Focus on management of the revenue cycle process Discuss the revenue cycle process
The Third National Medicare RAC Summit
The Third National Medicare RAC Summit Major Hospital Vulnerabilities II: Medical Necessity and Clinical Documentation Issues in Medicaid and RAC Audits Edmund L. Lafer, MD Temple University Health System
The RN-Coder Network 1142 S. Diamond Bar Blvd. Suite 796 Diamond Bar, CA 91765 www.rn-coder.com www.rn-auditor.com www.rncodericd10.com 909.579.
Services Overview The RN-Coder Network is pleased to offer a variety of health information management (HIM) and medical coding solutions for healthcare facilities throughout the country. RN-CODER will
MORRISTOWN MEDICAL CENTER INCORRECTLY BILLED MEDICARE INPATIENT CLAIMS WITH KWASHIORKOR
Department of Health and Human Services OFFICE OF INSPECTOR GENERAL MORRISTOWN MEDICAL CENTER INCORRECTLY BILLED MEDICARE INPATIENT CLAIMS WITH KWASHIORKOR Inquiries about this report may be addressed
Regulatory Updates for Outpatient Rehab + Documentation Audit - Next Steps
Regulatory Updates for Outpatient Rehab + Documentation Audit - Next Steps P.J. Rhoades PT, DPT, MS, CHC Director of Compliance and Denials Management Objectives Discuss changes in regulation for outpatient
The False Claims Act: Hospital Strategies to Avoid Business Ending Fines
The False Claims Act: Hospital Strategies to Avoid Business Ending Fines Past, Present and Future Impacts of the Law, Related Laws and Regulations SLIDE 1 Your Presenter Timothy Powell, CPA has over 30
Transformational Data-Driven Solutions for Healthcare
Transformational Data-Driven Solutions for Healthcare Transformational Data-Driven Solutions for Healthcare Today s healthcare providers face increasing pressure to improve operational performance while
Importance of Auditing
Medicare 201: Practitioner Importance of Auditing EY Fraud Investigation and Dispute Services Jennifer Shimek, Senior Manager Gretchen Segado, Manager Agenda Importance of Auditing National and Local Coding
COLLABORATIVE CARE MANAGEMENT. throughout the continuum
COLLABORATIVE CARE MANAGEMENT throughout the continuum OPTIONAL modules Morrisey helps hospitals and other healthcare providers achieve measurable clinical, process and financial outcomes. Our products
AGA Kansas City Chapter Data Analytics & Continuous Monitoring
AGA Kansas City Chapter Data Analytics & Continuous Monitoring Agenda Market Overview & Drivers for Change Key challenges that organizations face Data Analytics What is data analytics and how can it help
Basic CPT Coding, Part I
Basic CPT Coding, Part I Course Description The purpose of this course is to provide students with the basic principles of CPT coding and classification systems, the sequencing of codes and impact on reimbursement,
How To Replace A Billing Service
Selecting a Billing Service Are you considering a transition from an in-house billing department to a billing service, or thinking of replacing your current billing service? This checklist will help you
Best Practices: Physician Billing/Coding for Hospice & Palliative Care
Best Practices: Physician Billing/Coding for Hospice & Palliative Care Presented by: Christopher P. Acevedo, CHC, CPC Objectives Describe the circumstances that allow physician visits to be separately
RAC Preparation 7 Key Steps and Best Practices
McGuireWoods Health Care practice is ranked 6th largest in the country by the American Health Lawyers Association. RAC Preparation 7 Key Steps and Best Practices Elissa K. Moore, Associate 704.343.2218
Postacute Care Transfer Rule Review. HFMA Northern California COMPLIANCE WEBINAR SERIES California Statewide Webinar February 2012.
Postacute Care Transfer Rule Review HFMA Northern California COMPLIANCE WEBINAR SERIES California Statewide Webinar February 2012 Speaker Gloryanne Bryant, RHIA, RHIT, CCS, CCDS Regional Managing Director
Our clients count on us, and we deliver.
Experts in Revenue Cycle Management For Medical Practices and Imaging Centers For over 20 years, we have forged successful partnerships with medical practices and imaging centers to improve their revenue
Surgical/ASC Claims Revenue Cycle Management: An Introduction to Our Processes and Protocols
Surgical/ASC Claims Revenue Cycle Management: An Introduction to Our Processes and Protocols 200 Old Country Road, Suite 470 Mineola, NY 11501 Phone: 516-294-4118 Fax: 516-294-9268 www.businessdynamicslimited.com