Office of Corporate Compliance Audit Status Update [DATE]
[YEAR] Compliance Audit Work Plan Items: Facilities
Compliance Audit |
Facility |
Auditors |
Estimated Timing |
Estimated Hours |
---|---|---|---|---|
Ambulatory Surgery Unit Coding and Billing |
XYZ |
Internal |
Q1 |
50 |
Inpatient Rehabilitation Facility |
GHI |
Consultant |
Q1 |
50 |
Facility Emergency Department Coding and Billing |
XYZ |
Internal |
Q1 |
50 |
Skilled Nursing Facility Resource Utilization Group Coding |
ABC |
Consultant |
Q2 |
100 |
Inpatient Psychiatric Coding |
GHI |
Consultant |
Q2 |
50 |
Outpatient Psychiatric Coding |
XYZ |
Consultant |
Q2 |
50 |
Facility Emergency Department Coding and Billing |
ABC |
Internal |
Q2 |
50 |
Ancillary Services Lab |
GHI |
Consultant |
Q2 |
50 |
Ancillary Services Pharmacy |
XYZ |
Consultant |
Q2 |
50 |
Ancillary Services Respiratory Therapy |
ABC |
Consultant |
Q2 |
50 |
Ancillary Services Radiology |
GHI |
Consultant |
Q2 |
50 |
Radiology |
XYZ |
Internal |
Q2 |
50 |
Inpatient Psychiatric Coding |
ABC |
Consultant |
Q2 |
50 |
[YEAR] Compliance Audit Work Plan Items
Compliance Audit |
Facility |
Auditors |
Estimated Timing |
Estimated Hours |
---|---|---|---|---|
Clinical Research Billing |
ABC |
Consultant |
Q2 |
75 |
Outpatient Chemical Dependence Services |
GHI |
Internal |
Q3 |
50 |
End-Stage Renal Disease Prospective Payment System |
XYZ |
Consultant |
Q3 |
50 |
Early Intervention |
ABC |
Internal |
Q3 |
50 |
Outpatient Mental Health Services |
GHI |
Internal |
Q3 |
50 |
Partial Hospitalization |
XYZ |
Internal |
Q3 |
50 |
Day Treatment |
ABC |
Internal |
Q3 |
50 |
Day Habilitation |
GHI |
Internal |
Q3 |
50 |
Follow-up Reviews, Home Health |
GHI |
Internal |
Q4 |
50 |
Follow-up Reviews, Home Health |
XYZ |
Internal |
Q4 |
50 |
Follow-up Reviews of Skilled Nursing Facilities |
ABC |
Internal |
Q4 |
50 |
Follow-up Reviews of Skilled Nursing Facilities |
GHI |
Internal |
Q4 |
50 |
Follow-up Reviews of Hospice |
XYZ |
Internal |
Q4 |
50 |
Total Hours: |
675 |
[YEAR] Compliance Audit Work Plan Items: Professional Fee
Compliance Audit |
Facility |
Auditors |
Estimated Timing |
Estimated Hours |
---|---|---|---|---|
Professional Fee Reaudits |
Various |
Internal |
Q2 |
400 |
Independent Therapists: High Utilization of Outpatient Physical Therapy Services |
Various |
Consultant |
Q2 |
50 |
High-Volume Providers by Specialty |
Various |
Consultant |
Q2 |
100 |
Ophthalmological Services |
Various |
Internal |
Q2 |
50 |
Anesthesia Services: Payments for Personally Performed Services (Pain Management) |
Various |
Consultant |
Q2 |
50 |
Electrodiagnostic Testing, Cardiology |
Various |
Internal |
Q2 |
50 |
Physicians: Impact of Opting Out of Medicare |
Various |
Internal |
Q2 |
50 |
Evaluation and management Services: Cut and Paste |
Various |
Internal |
Q2 |
150 |
Medicaid Rate Part B Carve-Out |
Various |
Consultant |
Q2 |
50 |
Total Hours: |
950 |
[YEAR] Compliance Work Plan Items: Data Mining Reviews
Compliance Audit |
Facility |
Auditor |
Estimated Timing |
Estimated Hours |
---|---|---|---|---|
Extensive Operating Room Procedures Reaudit |
Various |
Consultant |
Q1 |
40 |
Diabetes Medicare Severity Diagnosis-Related Groups (MS-DRGs) 637–639 |
Various |
Internal |
Q1 |
80 |
Transient Ischemia Attack MS-DRG 069 |
Various |
Consultant |
Q1 |
40 |
Gastroenterology Bleed MS-DRGs 377–379 |
Various |
Consultant |
Q1 |
40 |
Syncope |
Various |
Internal |
Q1 |
80 |
IV Hydration Units |
Various |
Internal |
Q1 |
40 |
Pulmonary Edema and Respiratory Failure MS-DRGs 189/087 |
Various |
Consultant |
Q1 |
40 |
Excisional Debridement |
Various |
Consultant |
Q1 |
40 |
Ultrasound |
Various |
Internal |
Q1 |
40 |
Place-of-Service Errors in an Ambulatory Surgery Unit Setting |
Various |
Internal |
Q1 |
40 |
Colonoscopy Units |
Various |
Internal |
Q3 |
40 |
Present on Admission Indicators |
Various |
Internal |
Q3 |
40 |
Total Hours: |
560 |
[YEAR] Compliance Audit Work Plan Items: Non-Coding Audits
Compliance Audit |
Facility |
Auditors |
Estimated Timing |
Estimated Hours |
---|---|---|---|---|
Review Termination Procedures |
N/A |
Internal |
Q2 |
25 |
Benchmark Patient Satisfaction Scores Regarding Patient Privacy |
N/A |
Internal |
Q2 |
30 |
Employee Conflicts of Interest (COI) Audit |
N/A |
Internal |
Q2 |
25 |
Audit of the Physician COI Disclosure Forms |
N/A |
Internal |
Q2 |
50 |
Create Additional COI Procurement Control |
N/A |
Internal |
Q2 |
10 |
Review of Physician Practices Coding Procedures |
N/A |
Internal |
Q2 |
10 |
Verify Medicare Inpatient Coding Education on New [YEAR] Codes |
N/A |
Internal |
Q2 |
10 |
Electronic Health Record Compliance–Related Policies |
N/A |
Internal |
Q2 |
50 |
Review Managed Care Denial Data |
N/A |
Internal |
Q2 |
10 |
Professional Fee Data Mining Application |
N/A |
Internal |
Q2 |
25 |
Review Professional Fee Denial Data |
N/A |
Internal |
Q2 |
10 |
Compliance Integration |
N/A |
Internal |
Q2 |
10 |
Review Documentation Related to Physician Administrative Function Contracts |
N/A |
Internal |
Q2 |
20 |
Verify Compliance with the On-Call Coverage Payments |
N/A |
Internal |
Q2 |
20 |
Verify Compliance with Stark and Anti-Kickback EMR Safe Harbors and Exceptions |
N/A |
Internal |
Q2 |
10 |
New Health Insurance Portability and Accountability Act (HIPAA) Rule Implementation |
All |
Internal |
Q1–Q3 |
400 |
Revise Identity Theft Policy and Review Identity Theft Education |
N/A |
Internal |
Q2 |
25 |
Implementation of HIPAA Monitoring and Detection Application |
N/A |
Internal |
Q2 |
100 |
HIPAA Control for Posting Public and Internal Data on Websites |
N/A |
Internal |
Q2 |
10 |
Enhance HIPAA Accounting of Disclosure Process |
N/A |
Internal |
Q2 |
10 |
Revision of HIPAA Security Policies |
N/A |
Internal |
Q2 |
25 |
Revision of HIPAA Privacy Policies |
N/A |
Internal |
Q2 |
50 |
HIPAA Security Training Awareness |
N/A |
Internal |
Q2 |
50 |
Verify Appropriate Use of Email with Mental Health Patients |
N/A |
Internal |
Q2 |
20 |
Review Facility Directory Privacy Request Process |
N/A |
Internal |
Q2 |
20 |
Disposal of Protected Health Information |
N/A |
Internal |
Q2 |
10 |
Implement Privacy Control to Protect Texting of Patient Information |
N/A |
Internal |
Q2 |
10 |
Implement Additional Training on Protecting Patient Information on Medical Shift Reports |
N/A |
Internal |
Q2 |
10 |
Review Sensitive Patient Identifiers on Clinical and Business Forms |
N/A |
Internal |
Q2 |
40 |
Identify Additional Training on Medical Identity Theft |
N/A |
Internal |
Q2 |
20 |
New COI Tracking System |
N/A |
Internal |
Q2 |
30 |
Review the Gifts and Interactions with Industry Policy |
N/A |
Internal |
Q2 |
10 |
Verify Physician Payments Sunshine Reporting Entities |
N/A |
Internal |
Q2 |
10 |
Institutional COI Policy |
N/A |
Internal |
Q2 |
20 |
Review Inpatient Federal Health Care Program Denial Data |
N/A |
Internal |
Q2 |
10 |
Compliance with New Requirements for Outpatient Physical Therapy Cases |
N/A |
Internal |
Q2 |
10 |
Verify Compliance with CMS’ Adverse Event Restraints Regulation |
N/A |
Internal |
Q2 |
10 |
Compliance Survey |
N/A |
Internal |
Q2 |
20 |
Verify the Implementation of the Revised Physician Education Program for New Physician Employees and Credentialed Physicians |
N/A |
Internal |
Q2 |
10 |
Verify the Implementation of the Revised COI Process for New Physician Employees and Credentialed Physicians |
N/A |
Internal |
Q2 |
10 |
Marketing Analysis of Compliance Intranet and Internet Sites |
N/A |
Internal |
Q2 |
10 |
Compliance Helpline Utilization Review |
N/A |
Internal |
Q2 |
10 |
Skilled Nursing Facility Compliance Plans |
N/A |
Internal |
Q2 |
40 |
New Physician Location Education Rollout Project |
N/A |
Internal |
Q2 |
20 |
Office of Corporate Compliance Documentation |
N/A |
Internal |
Q2 |
10 |
Implementation of Health System’s Financial Assistance Program |
N/A |
Internal |
Q2 |
10 |
Assist with the Development of a Compliance Managed Care Plan |
N/A |
Internal |
Q2 |
100 |
Home Care Network Vendor Agency Exclusion Screening Process |
N/A |
Internal |
Q2 |
20 |
Review Office of Inspector General’s New Exclusion Screening Guidance |
N/A |
Internal |
Q2 |
20 |
Review Fair Market Valuation of Physician Compensation |
N/A |
Internal |
Q2 |
10 |
Evaluate Compliance Joint Venture Controls |
N/A |
Internal |
Q2 |
25 |
Revise Emergency Medical Treatment and Labor Act (EMTALA) Policy |
N/A |
Internal |
Q2 |
10 |
TOTAL: |
1,540 |
[YEAR] Compliance Work Plan Items: HIPAA
Compliance Audit |
Facility |
Auditor |
Estimated Timing |
Estimated Hours |
---|---|---|---|---|
Electronic Medical Record Access Audit |
ABC |
Internal |
Q1 |
40 |
Electronic Medical Record Access Audit |
GHI |
Internal |
Q2 |
40 |
Electronic Medical Record Access Audit |
XYZ |
Internal |
Q2 |
40 |
Electronic Medical Record Access Audit |
ABC |
Internal |
Q2 |
40 |
Electronic Medical Record Access Audit |
GHI |
Internal |
Q3 |
40 |
Electronic Medical Record Access Audit |
XYZ |
Internal |
Q3 |
40 |
Electronic Medical Record Access Audit |
ABC |
Internal |
Q3 |
40 |
Electronic Medical Record Access Audit |
GHI |
Internal |
Q3 |
40 |
Electronic Medical Record Access Audit |
XYZ |
Internal |
Q3 |
160 |
HIPAA Rounding Audit |
ABC |
Internal |
Q1 |
15 |
HIPAA Rounding Audit |
GHI |
Internal |
Q1 |
15 |
HIPAA Rounding Audit |
XYZ |
Internal |
Q1 |
15 |
HIPAA Rounding Audit |
ABC |
Internal |
Q1 |
15 |
HIPAA Rounding Audit |
GHI |
Internal |
Q1 |
15 |
HIPAA Rounding Audit |
XYZ |
Internal |
Q1 |
15 |
HIPAA Rounding Audit |
ABC |
Internal |
Q1 |
15 |
HIPAA Rounding Audit |
GHI |
Internal |
Q1 |
15 |
HIPAA Rounding Audit |
XYZ |
Internal |
Q1 |
15 |
HIPAA Rounding Audit |
ABC |
Internal |
Q1 |
15 |
HIPAA Rounding Audit |
GHI |
Internal |
Q1 |
15 |
HIPAA Rounding Audit |
XYZ |
Internal |
Q1 |
15 |
HIPAA Rounding Audit |
ABC |
Internal |
Q2 |
15 |
HIPAA Rounding Audit |
GHI |
Internal |
Q2 |
15 |
HIPAA Rounding Audit |
XYZ |
Internal |
Q2 |
15 |
HIPAA Rounding Audit |
ABC |
Internal |
Q2 |
15 |
HIPAA Rounding Audit |
GHI |
Internal |
Q2 |
15 |
HIPAA Rounding Audit |
XYZ |
Internal |
Q2 |
15 |
HIPAA Rounding Audit |
ABC |
Internal |
Q2 |
15 |
HIPAA Rounding Audit |
GHI |
Internal |
Q2 |
15 |
HIPAA Rounding Audit |
XYZ |
Internal |
Q2 |
15 |
HIPAA Rounding Audit |
ABC |
Internal |
Q2 |
15 |
HIPAA Rounding Audit |
GHI |
Internal |
Q3 |
15 |
HIPAA Rounding Audit |
XYZ |
Internal |
Q3 |
15 |
HIPAA Rounding Audit |
ABC |
Internal |
Q3 |
15 |
HIPAA Rounding Audit |
GHI |
Internal |
Q3 |
15 |
Business Associate Agreement Reviews |
XYZ |
Internal |
Q2 – Q4 |
100 |
HIPAA Rounding Audit |
ABC |
Internal |
Q1 |
15 |
HIPAA Rounding Audit |
GHI |
Internal |
Q2 |
15 |
Total Hours: |
1,000 |
[YEAR] Special Requests and Investigations
Audit in Progress |
Contact |
Audit Status |
Comments |
Corrective Action |
---|---|---|---|---|
XXXXX |
X. XYZ |
Progressing |
None |
N/A |
XXXXXX |
A. ABC |
Closed |
None |
Corporate Compliance to educate appropriate staff |
[YEAR] Compliance Professional Fee Audits in Progress
Audit in Progress |
Contact |
Audit Stage |
Audit Status |
Comments |
Corrective Action |
---|---|---|---|---|---|
XXXXXX |
X. XYZ |
Field Work |
Progressing |
None |
N/A |
XXXXXX |
A. ABC |
Field Work |
Progressing |
None |
N/A |
[YEAR] Compliance Facility Audits in Progress
Audit in Progress |
Contact |
Audit Stage |
Audit Status |
Comments |
Corrective Action |
---|---|---|---|---|---|
XXXXXX |
X. XYZ |
Field Work |
Progressing |
None |
N/A |
XXXXXX |
A. ABC |
Field Work |
Progressing |
None |
N/A |
[YEAR] Compliance Data-Mining Audits in Progress
Audit in Progress |
Contact |
Audit Stage |
Audit Status |
Comments |
Corrective Action |
---|---|---|---|---|---|
XXXXXX |
X. XYZ |
Field Work |
Progressing |
None |
N/A |
XXXXXX |
A. ABC |
Field Work |
Progressing |
None |
N/A |
[YEAR] Compliance Audit Non-Coding Reviews in Progress
Audit in Progress |
Contact |
Audit Stage |
Audit Status |
Comments |
Corrective Action |
---|---|---|---|---|---|
XXXXXX |
X. XYZ |
Field Work |
Progressing |
None |
N/A |
XXXXXX |
A. ABC |
Field Work |
Progressing |
None |
N/A |
OMIG Audits
Audit in Progress |
Letter Date |
Status |
Audit Timeframe and Recoupment |
---|---|---|---|
XXXXXX |
XX/XX/XX |
Open |
XX/XX/XX-XX/XX/XX |
XXXXXXXXX |
XX/XX/XX |
Closed |
XX/XX/XX-XX/XX/XX $ |
Office of Inspector General Audits
Audit in Progress |
Letter Date |
Status |
Audit Timeframe and Recoupment |
---|---|---|---|
XXXXXX |
XX/XX/XX |
Open |
XX/XX/XX-XX/XX/XX |
XXXXXXXXX |
XX/XX/XX |
Closed |
XX/XX/XX-XX/XX/XX |