EA-0404（認定書）写Title EA-0404（認定書）写 Created Date 1/27/2017 8:25:30 PM
Print - Hayes MDaudit Billing Compliance and Revenue ... · CHALLENGES FOR COMPLIANCE OFFICERS...
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• Don’t know what you don’t know • May be missing true risk areas • Lack of resources limits auditing reach Meeting Increased Regulatory Requirements Limited Resources Increased responsibilities Need to show value to leadership PITFALLS OF PERIODIC AUDITS CHALLENGES FOR COMPLIANCE OFFICERS 617-559-0404 PM SYSTEMS INDUSTRY POISED FOR GROWTH THE ROAD TO RISK-BASED AUDITING MAKING THE MOVE TO RISK-BASED AUDITING FROM RISK IDENTIFICATION TO RISK MANAGEMENT Feedback to Stakeholders Improvement Identify Risk Areas Ongoing Monitoring Periodic • Time-based • Every provider • Random sampling • Dispersed resources • Periodic identification • Arbitrary detection • Uncovers discrete instances Risk-Based • Issue-based • High, moderate risk providers • Targeted sampling • Focused resources • Continuous monitoring • Early detection • Analyzes trends PERIODIC AUDITS VS. RISK-BASED AUDITING LEVERAGE REAL-TIME SOURCE DATA • Direct data from your system 835/837s • Eliminates distortion of data • Enables more effective, faster analysis • Allows more relevant benchmarking to peer organizations CLASSIFY PROVIDERS BY RISK • High Risk: Series of failed routine audits requiring re-audits • Moderate Risk: Multiple consecutive passed audits with some high-risk findings • Low Risk: Multiple consecutive passed audits with no high-risk findings IDENTIFY RISK AREAS • Use data mining tools • Highlight outliers • Use worksheets to ensure standardized audit evaluation GO LIVE! • Plan, Do, Check, Act EVALUATE THE STATE OF YOUR CURRENT PROGRAM • Resources • Providers • Approach ANALYZE IMPACT/BENEFITS OF RISK-BASED AUDIT STRATEGY • Better utilization of resources • Improve chances of uncovering problems • Early detection & trend analysis DEVELOP YOUR PLAN • Timeline with milestones • Software acquisition • Implementation • Conversion GAIN LEADERSHIP BUY-IN • Improve efficiency and productivity • Reduce risks • Better utilization of resources WWW.HAYESMANAGEMENT.COM 1 2 3 4 5 6 7 8 8 STEPS TO RISK-BASED AUDITING
Transcript of Print - Hayes MDaudit Billing Compliance and Revenue ... · CHALLENGES FOR COMPLIANCE OFFICERS...
• Don’t know what you don’t know• May be missing true risk areas• Lack of resources limits auditing reach
Meeting Increased Regulatory
Requirements
LimitedResources
Increasedresponsibilities
Need to showvalue to leadership
PITFALLS OF PERIODIC AUDITS
CHALLENGES FOR COMPLIANCE OFFICERS
617-559-0404
PM SYSTEMS INDUSTRY POISED FOR GROWTH
THE ROAD TO RISK-BASED AUDITING
MAKING THE MOVE TO RISK-BASED AUDITING
FROM RISK IDENTIFICATION TO RISK MANAGEMENT
Feedback toStakeholders Improvement
Identify RiskAreas
OngoingMonitoring
Periodic
• Time-based• Every provider• Random sampling• Dispersed resources• Periodic identification• Arbitrary detection• Uncovers discrete instances
Risk-Based
• Issue-based• High, moderate risk providers• Targeted sampling• Focused resources• Continuous monitoring• Early detection• Analyzes trends
PERIODIC AUDITS VS. RISK-BASED AUDITING
LEVERAGE REAL-TIME SOURCE DATA
• Direct data from yoursystem 835/837s
• Eliminates distortion ofdata
• Enables more effective,faster analysis
• Allows more relevantbenchmarking to peerorganizations
CLASSIFY PROVIDERS BY RISK
• High Risk: Series offailed routine auditsrequiring re-audits
• Moderate Risk:Multiple consecutivepassed audits withsome high-risk findings
• Low Risk: Multipleconsecutive passedaudits with no high-riskfindings
IDENTIFY RISK AREAS
• Use data mining tools• Highlight outliers• Use worksheets to
ensure standardizedaudit evaluation
GO LIVE!
• Plan, Do, Check, Act
EVALUATE THE STATE OF YOUR
CURRENT PROGRAM
• Resources• Providers• Approach
ANALYZE IMPACT/BENEFITS
OF RISK-BASED AUDIT STRATEGY
• Better utilization ofresources
• Improve chances ofuncovering problems
• Early detection & trendanalysis
DEVELOP YOUR PLAN
• Timeline withmilestones
• Software acquisition• Implementation• Conversion
GAIN LEADERSHIP BUY-IN
• Improve efficiency andproductivity
• Reduce risks• Better utilization of
resources
WWW.HAYESMANAGEMENT.COM
1 2 3 4
5 6 7 8
8 STEPS TO RISK-BASED AUDITING
