Common Monitoring Examples for a Hospital | COSMOS Compliance Universe

Common Monitoring Examples for a Hospital

By Sheila Limmroth, CIA, CHC; Debra A. Muscio, MBA, CFE, CCE, CHC, CHP, CHIAP; Andrea Seykora, JD, CIP; Melinda Allie; and Joette P. Derricks, FACMPE, CHC, CPC, LSSGB


Hospital Department	Monitoring Examples
Scheduling	Prior authorization (completion before appointment) Registration errors, insurance verification (completion prior to appointment)
Registration	Insurance verification (completed during check-in) Medicare secondary payer questionnaire Assignment of benefits Notice of Privacy Practices
Records Management	Number or % of orders unsigned (electronic medical record [EMR] reports) Average lag time for cosigning verbal orders (EMR reports) Number or % of incomplete records, types of reports, etc. Quality management program for misfiled or commingled patient records
Coding	Coding quality management program results Number or % of coding changes made by personnel (physician charges) Productivity reports
Care Coordination	% of admissions seen within 24 hours of admission % of admissions sent to physician review for medical necessity Five physician reviews maintained as an inpatient admission
Patient Financial Services	Claims submission scrubber rejection data and trending Denial management tracking denial codes by payer, provider, and specific segments of the revenue cycle Payment posting adjustments due to denials
Information Technology	Access monitoring Timely termination of employees from the system in accordance with policy Validation of users on the system Validation of access based on role
Staff Training	Training materials current and reflective of important regulatory updates Pass/fail rate of training certifications Every staff member has completed a training attestation form Instructor quality of training
Finance	Physician transactions/arrangements Vendor exclusion checks Office space lease arrangements Vendor rebates
Marketing	Marketing activities to Medicare patients Philanthropy marketing to patients and HIPAA
Patient Advocate	Incident reports or grievances related to billing, privacy, or security Timely response to grievances
Charge Capture (any revenue-generating department)	Charging error reports sent to departments Charging work queues Charging errors identified or corrected by health information management Charges without orders