With the sea of ever changing healthcare regulations it is important that organizations conduct regular and ongoing internal audit and compliance program assessments. Within the last decade the healthcare arena has witnessed sweeping regulatory changes, including:
- Compliance with the Patient Protection and Affordable Care Act (PPACA),
- Implementation of International Classification of Diseases, Tenth Revision (ICD-10),
- Demands related to Recovery Audit Contractor (RAC), and
- Security and privacy issues related to the increased use of social media, cloud based technology and smart-devices, and
- The ability to meet new compliance requirements and industry standards.
These changes require healthcare organizations to take a deeper look at their infrastructure and operations. Now is the time to place high importance on identifying, prioritizing and thoroughly evaluating the risks impacting your organization. A strong internal audit and compliance program assessment will evaluate an organizations vulnerability to inherent industry risks, and more importantly risks specific to individual organizations operations.
Through our experience conducting comprehensive internal audit and compliance assessments we recommend the following:
- Assessing an organizations compliance program and/or operations against the seven (7) elements of an effective compliance program detailed by the Office of Inspector General (OIG).
- Performing an “effectiveness” assessment of education and training, internal investigations and remediation, and consistent discipline.
- Conducting a RATS-STATS billing claims audit and review to determine statistical error and/or reimbursement related error.
- Assessing organizational operations including, reporting structure, staffing assessment focused on staffing ratios and staffing skill, and process improvement and coordination.
Provident finds that organizations that complete ongoing audits and assessments see numerous benefits, including: increased accountability within the organization, early identification and remediation of issues and deficiencies, and an enforced process-dependent, as opposed to a person-dependent, environment.