BAYCARE PFS COMPLIANCE MATTERS May 18, 2016 HFMA CONFERENCE

Transcription

1 BAYCARE PFS COMPLIANCE MATTERS May 18, 2016 HFMA CONFERENCE

2 Overview BayCare Health System History BayCare Health System is a group of community health alliances with related businesses BCHS Formed in 1996 with seven hospitals, related business lines, and 13,000 employees Today BayCare is fourteen hospitals, related business lines and over 26,000 employees All hospitals are non profits located in Hillsborough, Pasco, Pinellas, Polk counties, and services the surrounding communities in the Tampa Bay Region. PFS Departments include Admitting/Registration, CBO, Financial Assistance, HIM, CDI, HHA CBO, and BMG CBO.

3 BayCare Health System Problem / Opportunity Continuous Compliance Training BayCare PFS Departments needed a compliance structure as a regional department in the Summer of 2001 for new CBO. Auditor position officially assumed 9/11/2001; we started with a PFS Compliance Plan, Proposed Audit Plan, and monthly meetings with Internal Audit. The rest of our committees followed. Expanded the Proposed Audit Plan/policy as the PFS Scope expanded; we added a PFS Compliance Analyst in The PFS Audit Team concentrated heavily on Admitting areas, the CBO, and then new business lines as they joined PFS regional structure. PFS Auditor worked closely with PFS trainers to develop cohesive Orientation and Refresher classes. Compliance monitoring reported regularly to PFS Management. Quality Checkers added.

4 BayCare Compliance System Structure BayCare Board Audit Sub Committee-CRC BCHS President Chief Compliance Officer & HIPAA Security Officer Corporate Responsibility Managers and CHA Level Officers and Committees Regional Vice Presidents have Internal Auditors who report to them Lynda Gorken is V.P for PFS and CBO. In PFS the PFS Audit Team Reports to the V.P. Formal Audit Roles We hold monthly compliance meetings with key players Forms Committee reports to the Auditor and V.P. PFS /CBO Policy and Procedure Committee monthly meetings to approve all PFS CBO committees CBO Safety Committee with Management Support Meetings Management Support Training Unit does Compliance Education

5 Goals-Create Structured Policies/Procedures & Compliance Committees Current State PFS Compliance Plan and Proposed Audit Plan annual updates PFS Audit Team-structured Reporting of Auditing and Monitoring activities to V.P. Work with Directors/Managers on improvements PFS Audit Annual Compliance Report Executive Summary to BayCare Corporate Responsibility Council Annual Admitting Compliance Award for best outcomes in KPI s. PFS Monthly Compliance Meetings with PFS V.P. and Directors of HIM, CDM, CRM, Financial Assistance, PFS Management Support, RCM, Internal Audit/CRC, CBO Billing, Admitting, and the BayCare Hospital Div. CFO. Agenda and minutes are maintained by Auditor Compliance related structure committees PFS Forms Committee, PFS Policy / Procedure Committee, and PFS Safety Committee. PFS Management Support Training Unit conducts classes for New Hire, Annual Refresher, and Special Targeted Education, i.e. Cyber security, Identity Theft, MSP Audits, and HIPAA- Compliance really matters here. Quality Checkers spot check admissions.

6 Goals-Created Current Awareness of Compliance Structured Policies/Procedures Training Management Support PFS Admitting Orientation 12 days Classroom training and CBO has nine days / competency testing Trainers follow up with observation sessions on new registrars Trainers handle retraining required for improving performance Annual Refresher Class one day PAS and CBO PFS Audit Team conducts random audits unannounced in Admitting areas and Business Offices, i.e. HIPAA walk through, direct observations and signage checks. Compliance presentations in department meetings. Admitting Annual Compliance Award yearly overall top scores attained on audits of completed: Patient Agreement Consents, MSPQ completion, IMM completion, Eligibility checking/hdx storage responses, and documentation required if not accomplished. Also conducts HIPAA reviews and Signage reviews. PFS Auditor monitors compliance areas in CBOs, i.e. A/R reviews, high dollar manual adjustments, policy development, forms development, training updates/reviews, and security reviews. Works with Internal Audit/CRC on new regulatory changes and implementation in PFS Areas.

7 PFS Compliance Plan - Elements Patient Financial Services Audit Work Plans Education and Training ongoing Communication Disciplinary and Corrective Action for team member failure to comply with the PFS Compliance Plan. Auditing and Monitoring for performance measures and compliance scoring Non-Employment or Retention of Sanctioned Individuals. Response to Offenses, Corrective Actions, and Prevention.

8 PFS Compliance Ongoing Access Compliance Policies and Department Policies Are Electronically Accessible Intranet under ACBO/CBO/Admitting/Reg Training manuals and resource documents Compliance Overview PFS incorporates and supports the seven elements of the BayCare Corporate Responsibility Program Reporting Structure is defined and maintained. Education and Certification or Formal Education required for key positions in PFS. We need career ladder increments. PFS Trainers conduct certification classes for certificate programs geared to CBO and Admitting Team Members. Outside Education and training is used to reinforce our training programs. Looks good in outside audits. PFS Audit Team is a resource for everyone on compliance matters. Open door policy and follow through reporting.

9 Revenue Cycle Bad Debt Processing Pre-Admit Contract Monitoring Admission Posting Patient Financial Services Patient Access Services Insurance Verification Follow up and Collections Billing Financial Counseling Billing Charge Capture Documentation Coding

10 PFS Compliance Matters Results and Lessons learned: A well educated and informed Team Member performs better What isn t measured and reported doesn t count. Monitoring key compliance measures helps ensure a complete and accurate patient encounter is created. Technology needs monitoring and improvement continually Ongoing improvements and updates to meet current regulations Our patients and families expect and deserve the highest quality of customer experience and service every day from Pre- Admission to final payment/settlement-we deliver. Compliance Matters- our motto is Doing the Right Thing Marty Lassiter, B.A. CRCE-I PFS Auditor BayCare Health Systems ph AAHAM Florida Sunshine President