This document discusses risks in the healthcare industry from an internal audit perspective. It begins by identifying major categories of risk faced by healthcare providers, such as legal/regulatory risks, reputation risks, and technology risks. It then provides an audit universe listing various IT systems and general control areas that should be examined to assess IT risks. Finally, it identifies some common high-risk IT areas including web applications, medical devices on the network, wireless networks, and application interfaces.
PYA Principal Carol Carden presented “Fundamentals of Healthcare Valuation” at the American Society of Appraisers (ASA) 2015 Advanced Business Valuation Conference. The presentation explored unique characteristics of the healthcare industry, particularly those relevant to appraisers for avoiding common mistakes in assessing risk and projecting cash flow.
PYA Healthcare Consulting Senior Manager Robert Mundy co-presented during, “Valuing Hospitals,” Thursday, July 31, at 1 p.m. EST. This webinar explores the changing world of hospital economics, regulations, and valuations and how appraisers can best prepare themselves for both the opportunities and challenges that lie ahead.
PYA Highlights Next Steps of Meaningful UsePYA, P.C.
At the 2013 AICPA Healthcare Industry Conference, PYA Principal David McMillan and Senior Manager Chris Wilson recently explored the “new normal” of meaningful use as compliance and strategic standards in new care/reimbursement-model development.
Surviving the Healthcare World of Risk AdjustmentPYA, P.C.
PYA Principal Bob Paskowski and Senior Staff Consultant Carine Leslie presented a webinar for the Georgia chapter of the Healthcare Financial Management Association Friday, December 16, 2016.
The presentation is tailored for coders in ambulatory/Medicare Advantage settings, providers participating in Medicare Advantage or other risk-based healthcare plans, and leaders in providers’ managed care contracting departments. The webinar is titled “Surviving the Healthcare World of Risk Adjustment.”
The webinar addresses:
• Principles of the Medicare Advantage risk-adjustment model from Medicare Advantage Hierarchical Condition Categories and other risk-based healthcare plans;
• Strategies for reducing compliance risks;
• Methods for accurately, completely, and consistently capturing and documenting a patient’s disease burden to promote effective care management and to reflect the proper risk score.
The Heartaches Associated with Billing for Cardiac DevicesPYA, P.C.
PYA Principal Denise Hall-Gaulin and Consulting Manager Joanna Malcolm presented a free webinar for the Georgia chapter of the Healthcare Financial Management Association, on Tuesday, December 6, 2016.
The presentation was geared toward C-suite hospital leaders, compliance officers, in-house counsel, operational leaders, and patient accounting leadership, and covered:
The criteria for implantable cardioverter defibrillators (ICDs), pacemakers, and other devices
The documentation requirements for payment
The prerequisites for a clean audit
Don’t Stumble Coming Out of the Gate –Top Ten Issues to Address When Acquirin...PYA, P.C.
PYA Consulting Principal Carol Carden co-presented with Charlene McGinty of McKenna Long. They examined the top issues to address when acquiring a physician practice and some of the common and more complex issues hospitals face during the acquisition.
PYA Principal Carol Carden presented “Fundamentals of Healthcare Valuation” at the American Society of Appraisers (ASA) 2015 Advanced Business Valuation Conference. The presentation explored unique characteristics of the healthcare industry, particularly those relevant to appraisers for avoiding common mistakes in assessing risk and projecting cash flow.
PYA Healthcare Consulting Senior Manager Robert Mundy co-presented during, “Valuing Hospitals,” Thursday, July 31, at 1 p.m. EST. This webinar explores the changing world of hospital economics, regulations, and valuations and how appraisers can best prepare themselves for both the opportunities and challenges that lie ahead.
PYA Highlights Next Steps of Meaningful UsePYA, P.C.
At the 2013 AICPA Healthcare Industry Conference, PYA Principal David McMillan and Senior Manager Chris Wilson recently explored the “new normal” of meaningful use as compliance and strategic standards in new care/reimbursement-model development.
Surviving the Healthcare World of Risk AdjustmentPYA, P.C.
PYA Principal Bob Paskowski and Senior Staff Consultant Carine Leslie presented a webinar for the Georgia chapter of the Healthcare Financial Management Association Friday, December 16, 2016.
The presentation is tailored for coders in ambulatory/Medicare Advantage settings, providers participating in Medicare Advantage or other risk-based healthcare plans, and leaders in providers’ managed care contracting departments. The webinar is titled “Surviving the Healthcare World of Risk Adjustment.”
The webinar addresses:
• Principles of the Medicare Advantage risk-adjustment model from Medicare Advantage Hierarchical Condition Categories and other risk-based healthcare plans;
• Strategies for reducing compliance risks;
• Methods for accurately, completely, and consistently capturing and documenting a patient’s disease burden to promote effective care management and to reflect the proper risk score.
The Heartaches Associated with Billing for Cardiac DevicesPYA, P.C.
PYA Principal Denise Hall-Gaulin and Consulting Manager Joanna Malcolm presented a free webinar for the Georgia chapter of the Healthcare Financial Management Association, on Tuesday, December 6, 2016.
The presentation was geared toward C-suite hospital leaders, compliance officers, in-house counsel, operational leaders, and patient accounting leadership, and covered:
The criteria for implantable cardioverter defibrillators (ICDs), pacemakers, and other devices
The documentation requirements for payment
The prerequisites for a clean audit
Don’t Stumble Coming Out of the Gate –Top Ten Issues to Address When Acquirin...PYA, P.C.
PYA Consulting Principal Carol Carden co-presented with Charlene McGinty of McKenna Long. They examined the top issues to address when acquiring a physician practice and some of the common and more complex issues hospitals face during the acquisition.
Revenue Cycle Management: Market Dynamics & Opportunities in a Changing Healt...Cognizant
Sourcing revenue cycle management can help healthcare insurers overcome growing reimbursement complexities. Yet providers say managing dozens of RCM vendors comes with its own complications. That’s why they’re increasingly sourcing comprehensive RCM solutions with a single vendor to generate greater efficiencies, reduce costs and improve patient satisfaction.
Healthcare Valuations in an Era of Reform and UncertaintyPYA, P.C.
PYA Principal Jim Lloyd's AICPA Health Care Industry Conference presentation explored reform and current environment highlights, healthcare transactions and affiliations, valuation considerations, and regulatory issues.
PYA Principal Carol Carden presented on current issues in healthcare valuation at The Texas Society of Certified Public Accountants Business Valuation, Forensic, and Litigation Services Conference at the Hilton Fort Worth, October 14, 2014.
Current Trends in Data Protection for Integrated Health, Centralized Peer Rev...PYA, P.C.
A webinar hosted by PYA and the Alliance for Quality Improvement (AQIPS) explored “Current Trends in Data Protection for Integrated Health, Centralized Peer Review Systems, and Other Innovative Programs.” PYA Principal Martie Ross participated in the webinar, which focused on how patient safety organization (PSO) protections can bring value to accountable care organizations and other integrated health systems.
In addition, the webinar provided instruction for using:
Patient Safety and Quality Improvement Act (PSQIA) protections in Medicare Shared Savings Programs, centralized peer review programs, and other collaboratives.
PSQIA protections for new types of clinical analysis, clinical quality reports, and performance tools that contain information that may not be protected under existing state peer review privilege or are shared among an integrated network.
Demystifying Commercial Reasonableness in Physician/Hospital TransactionsPYA, P.C.
PYA Principal Lyle Oelrich presented “Demystifying Commercial Reasonableness in Physician/Hospital Transactions” at the Georgia Society of Certified Public Accountants’ (GSCPA) 2016 Healthcare Conference, February 11, 2016, in Atlanta, Georgia.
PYA Principal Carol Carden recently spoke on the topic “Valuation Issues in Healthcare” at the Tennessee Society of Certified Public Accountants’ Healthcare Conference.
Office of Civil Rights HIPAA Audits Preparing Your Clients and YourselfPYA, P.C.
PYA Consulting Manager Susan Thomas presented “Office of Civil Rights HIPAA Audits – Preparing Your Clients and Yourself” at The Florida Bar’s “Representing the Physician: It Is Harder Than It Looks” conference, February 3, 2017, in Orlando, Florida.
The presentation covered topics that include:
The Health Information Technology for Economic and Clinical Health Act.
Phase 1 audit, privacy, security, and breach notification findings and lessons learned.
Phase 2 audits—scope and recipient selection.
HIPAA audit readiness and steps for preparing.
Personal reflections from an OCR breach investigation.
Audit resources for physician practices.
Presentation Offers Valuation Strategies for Tax-Effective Practice TransactionsPYA, P.C.
PYA Principal Jim Lloyd co-presented a session at the 2013 AICPA Healthcare Industry Conference in New Orleans on “Valuation Strategies for More Tax-Effective Physician/Dentist Practice Transactions.”
PYA Thought Leader Defines Role of Radiation Oncology in Clinical IntegrationPYA, P.C.
PYA Senior Consulting Manager Chris Wilson presented “Clinically Integrated Networks (CIN) and the Role for Radiation Oncology” at the SATRO® 16 Conference, April 24-25, 2014, at the Crowne Plaza Ravinia in Atlanta, Georgia.
Guide to CMS Comprehensive Care for Joint Replacement modelQ-Centrix
On April 1, the CMS Comprehensive Care for Joint Replacement (CCJR) model went into effect for nearly 800 hospitals in 67 markets nationwide. Essentially, CMS converted its voluntary payment model—Bundled Payment for Care Improvement (BPCI)—into a regulatory mandate that will hold hospitals accountable for spending by all healthcare providers for 90 days following the initial episode of care.
PYA Principal Jim Lloyd along with Polsinelli’s Douglas Anning presented “Doing the Deal” in which they utilized case studies in analyzing both hospital-hospital transactions and hospital-physician practice transactions. The presentation also covered:
Helping clients successfully negotiate and structure the transaction and keeping the deal on track
Recognizing sample contract provisions common to these types of deals
Working with valuation firms to ensure the transaction terms are within fair market value and commercially reasonable
Evaluating and dealing with potential anti-trust concerns
Dealing with potential compliance issues identified during the due-diligence process
Modern Physician-Hospital Affiliations in an Era of Increased Fraud and Abuse...PYA, P.C.
PYA Senior Manager Chris Beckham co-presented “Modern Physician-Hospital Affiliations in an Era of Increased Fraud and Abuse Scrutiny” with Ross Burris of Polsinelli at the American Health Lawyer Association’s (AHLA) Physicians and Hospitals Law Institute, February 8-10, 2016.
ICD-10 Is Really Here: What Does That Mean To Compliance Officers?PYA, P.C.
PYA Principal Denise Hall presented “ICD-10 Is REALLY Here: What Does that Mean to Compliance Officers?” at the THA 2015 Fall Compliance Conference. The presentation helps providers get “in tune” with the latest in ICD-10 compliance:
* A brief discussion of ICD-10 and its impact on healthcare.
* Compliance risks with the transition to the ICD-10 system.
* Mitigation of compliance risk and denial activities during and post-implementation.
* ICD-10’s impact on value-based purchasing and quality-based payment models.
PYA Principal Martie Ross joined University of Kansas Medical Center’s Robert Moser, MD, and CIO Chris Hansen for the keynote presentation at the joint symposium by Heart of America Healthcare Information and Management Systems Society and Missouri Health Information Management Association, September 14, 2016, at Johnson County Community College in Overland Park, Kansas. They discussed insights related to the role of advanced analytics and technology in transforming and transitioning to new payment models.
This is an introduction PPT to RCM (Revenue Cycle management) which provides a details information about the step to step process of RCM with workflows.
Revenue Cycle Management: Market Dynamics & Opportunities in a Changing Healt...Cognizant
Sourcing revenue cycle management can help healthcare insurers overcome growing reimbursement complexities. Yet providers say managing dozens of RCM vendors comes with its own complications. That’s why they’re increasingly sourcing comprehensive RCM solutions with a single vendor to generate greater efficiencies, reduce costs and improve patient satisfaction.
Healthcare Valuations in an Era of Reform and UncertaintyPYA, P.C.
PYA Principal Jim Lloyd's AICPA Health Care Industry Conference presentation explored reform and current environment highlights, healthcare transactions and affiliations, valuation considerations, and regulatory issues.
PYA Principal Carol Carden presented on current issues in healthcare valuation at The Texas Society of Certified Public Accountants Business Valuation, Forensic, and Litigation Services Conference at the Hilton Fort Worth, October 14, 2014.
Current Trends in Data Protection for Integrated Health, Centralized Peer Rev...PYA, P.C.
A webinar hosted by PYA and the Alliance for Quality Improvement (AQIPS) explored “Current Trends in Data Protection for Integrated Health, Centralized Peer Review Systems, and Other Innovative Programs.” PYA Principal Martie Ross participated in the webinar, which focused on how patient safety organization (PSO) protections can bring value to accountable care organizations and other integrated health systems.
In addition, the webinar provided instruction for using:
Patient Safety and Quality Improvement Act (PSQIA) protections in Medicare Shared Savings Programs, centralized peer review programs, and other collaboratives.
PSQIA protections for new types of clinical analysis, clinical quality reports, and performance tools that contain information that may not be protected under existing state peer review privilege or are shared among an integrated network.
Demystifying Commercial Reasonableness in Physician/Hospital TransactionsPYA, P.C.
PYA Principal Lyle Oelrich presented “Demystifying Commercial Reasonableness in Physician/Hospital Transactions” at the Georgia Society of Certified Public Accountants’ (GSCPA) 2016 Healthcare Conference, February 11, 2016, in Atlanta, Georgia.
PYA Principal Carol Carden recently spoke on the topic “Valuation Issues in Healthcare” at the Tennessee Society of Certified Public Accountants’ Healthcare Conference.
Office of Civil Rights HIPAA Audits Preparing Your Clients and YourselfPYA, P.C.
PYA Consulting Manager Susan Thomas presented “Office of Civil Rights HIPAA Audits – Preparing Your Clients and Yourself” at The Florida Bar’s “Representing the Physician: It Is Harder Than It Looks” conference, February 3, 2017, in Orlando, Florida.
The presentation covered topics that include:
The Health Information Technology for Economic and Clinical Health Act.
Phase 1 audit, privacy, security, and breach notification findings and lessons learned.
Phase 2 audits—scope and recipient selection.
HIPAA audit readiness and steps for preparing.
Personal reflections from an OCR breach investigation.
Audit resources for physician practices.
Presentation Offers Valuation Strategies for Tax-Effective Practice TransactionsPYA, P.C.
PYA Principal Jim Lloyd co-presented a session at the 2013 AICPA Healthcare Industry Conference in New Orleans on “Valuation Strategies for More Tax-Effective Physician/Dentist Practice Transactions.”
PYA Thought Leader Defines Role of Radiation Oncology in Clinical IntegrationPYA, P.C.
PYA Senior Consulting Manager Chris Wilson presented “Clinically Integrated Networks (CIN) and the Role for Radiation Oncology” at the SATRO® 16 Conference, April 24-25, 2014, at the Crowne Plaza Ravinia in Atlanta, Georgia.
Guide to CMS Comprehensive Care for Joint Replacement modelQ-Centrix
On April 1, the CMS Comprehensive Care for Joint Replacement (CCJR) model went into effect for nearly 800 hospitals in 67 markets nationwide. Essentially, CMS converted its voluntary payment model—Bundled Payment for Care Improvement (BPCI)—into a regulatory mandate that will hold hospitals accountable for spending by all healthcare providers for 90 days following the initial episode of care.
PYA Principal Jim Lloyd along with Polsinelli’s Douglas Anning presented “Doing the Deal” in which they utilized case studies in analyzing both hospital-hospital transactions and hospital-physician practice transactions. The presentation also covered:
Helping clients successfully negotiate and structure the transaction and keeping the deal on track
Recognizing sample contract provisions common to these types of deals
Working with valuation firms to ensure the transaction terms are within fair market value and commercially reasonable
Evaluating and dealing with potential anti-trust concerns
Dealing with potential compliance issues identified during the due-diligence process
Modern Physician-Hospital Affiliations in an Era of Increased Fraud and Abuse...PYA, P.C.
PYA Senior Manager Chris Beckham co-presented “Modern Physician-Hospital Affiliations in an Era of Increased Fraud and Abuse Scrutiny” with Ross Burris of Polsinelli at the American Health Lawyer Association’s (AHLA) Physicians and Hospitals Law Institute, February 8-10, 2016.
ICD-10 Is Really Here: What Does That Mean To Compliance Officers?PYA, P.C.
PYA Principal Denise Hall presented “ICD-10 Is REALLY Here: What Does that Mean to Compliance Officers?” at the THA 2015 Fall Compliance Conference. The presentation helps providers get “in tune” with the latest in ICD-10 compliance:
* A brief discussion of ICD-10 and its impact on healthcare.
* Compliance risks with the transition to the ICD-10 system.
* Mitigation of compliance risk and denial activities during and post-implementation.
* ICD-10’s impact on value-based purchasing and quality-based payment models.
PYA Principal Martie Ross joined University of Kansas Medical Center’s Robert Moser, MD, and CIO Chris Hansen for the keynote presentation at the joint symposium by Heart of America Healthcare Information and Management Systems Society and Missouri Health Information Management Association, September 14, 2016, at Johnson County Community College in Overland Park, Kansas. They discussed insights related to the role of advanced analytics and technology in transforming and transitioning to new payment models.
This is an introduction PPT to RCM (Revenue Cycle management) which provides a details information about the step to step process of RCM with workflows.
Medical Bill Auditing services - HMS USAHMS USA INC
Efficient Revenue Cycle Management
HMS USA is a leading medical billing service provider dedicated to maximizing the revenue cycle of healthcare professionals and other organizations. The company specializes in streamlining the intricate procedure of billing medical expenses and ensuring precision, compliance, and prompt reimbursement.
Comprehensive Billing Solutions
HMS USA offers comprehensive medical billing services to meet healthcare professionals' specific demands. This includes patient demographic entry, charge capture, claims submission and payment posting, denial management, and appeals processing. The end-to-end billing solutions offered by the company are designed to improve efficiency in financial management and ease the administrative burden for healthcare professionals.
Industry Compliance Expertise
The complex world of healthcare regulation and compliance with standards is essential for efficient medical billing. HMS USA is dedicated to staying up to date with the most recent regulatory requirements in the industry, including HIPAA and other guidelines pertinent to the field. Through strict compliance with regulations for compliance, they ensure the integrity and confidentiality of information about patients.
Cutting-Edge Technology Integration
Utilizing cutting-edge technology, HMS USA leverages state-of-the-art billing software to increase efficiency and accuracy. Automated claims processing and electronic submissions accelerate reimbursement processes, reducing errors and improving financial performance overall for healthcare professionals.
Customized Analytics and Reporting
The financial condition of a healthcare practice is essential for making strategic decisions. HMS USA provides detailed and specific reports and analytics, providing insights into the most critical performance indicators, revenue trends, and improvement areas. Healthcare professionals can make informed choices to improve the financial performance of their practices.
Patient-Focused Methodology
In recognition of the importance of customer happiness, HMS USA implements patient-friendly billing procedures. Transparent and clear communication regarding the billing process, simple statements, and prompt customer support all contribute to a positive experience for the patient.
Responsive Customer Service
HMS USA prides itself on providing exceptional customer service. Their billing specialists are always available to answer questions, resolve issues, or advice on improving billing processes. The company's commitment to prompt customer service allows for a seamless and productive partnership between healthcare professionals.
In summation, HMS USA is a reliable partner in the health industry and offers a range of medical billing services specifically designed to boost revenue, decrease administrative burdens, and promote the financial viability of healthcare providers. For the most current and current information, go to the latest information at HMS USA directly.
The Top Seven Healthcare Outcome Measures and Three Measurement EssentialsHealth Catalyst
Healthcare outcomes improvement can’t happen without effective outcomes measurement. Given the healthcare industry’s administrative and regulatory complexities, and the fact that health systems measure and report on hundreds of outcomes annually, this article adds much-needed clarity by reviewing the top seven outcome measures, including definitions, important nuances, and real-life examples. The top seven categories of outcome measures are:
Mortality
Readmissions
Safety of care
Effectiveness of care
Patient experience
Timeliness of care
Efficient use of medical imaging
CMS used these seven outcome measures to calculate overall hospital quality and arrive at its 2018 hospital star ratings. This article also reiterates the importance of outcomes measurement, clarifies how outcome measures are defined and prioritized, and recommends three essentials for successful outcomes measurement.
Please follow instructions carefully. Thank you so kindly. Ass.docxmattjtoni51554
Please follow instructions carefully. Thank you so kindly.
Assignment 1 “Changes in Human Resource Management (HRM) and Employment Law" Please respond to the following: 1 and ½ half pages with references
· Based on the assigned chapters this week, identify three (3) key changes that have advanced HR and provide a justification to support your selection.
· From this week’s assigned reading, choose one (1) historical government HR regulation enacted and elaborate on how this new mandate affected all stakeholders involved. Recall stakeholders in any industry, and cover those directly involved and their communities.
Assignment 2 "Human Resources Activities and Relationships" Please respond to the following:
1 and ½ half pages with references
· Considering the services provided by a hospital HR department, how do most HR specialists deal with employee scarcity like nursing shortages when trying to hire the best professionals?
· What leadership and management skill sets are useful for retaining good employees and deferring employee turnover?
Assignment 3
Job Descriptions and Employee Training and Development" Please respond to the following:
2 pages with references
· Go to the Joint Commission’s Website located at http://www.jointcommission.org/standards_information/jcfaq.aspx. At “Standards FAQs,” select a field-related manual category from the drop-down list, type in “human resources” in the “Optional Keyword” box, and then click the “Go” button. Next, provide an example of how the Joint Commission has influenced a specific function of HR in a healthcare organization.
· Recommend a specific employee training method that you think would be most effective for a healthcare organization, and determine one advantage and one disadvantage of your chosen training method. Provide support for your rationale.
The New Focus on Quality and Outcomes
Introduction
In 1999, the Institute of Medicine (IOM) published a groundbreaking analysis of the impact of medical errors on the health care delivery system and the patients it serves. The analysis, published as "To Err is Human: Building a Safer Healthcare System," concluded that medical errors resulted in up to 98,000 patient deaths in American hospitals every year. This report hit the national press and participants in the health care system and the political system with the force of a large bomb. Since that time, hospitals and other health care entities have refocused their attention on quality, errors, and patient safety in an unprecedented way, urged on by public outcry and by federal and state efforts to compel improvements in the health care system. Such entities as the Institute for Healthcare Improvement (www.ihi.org) the National Quality Forum (www.qualityforum.org), and the Institute of Medicine (www.iom.edu) have all emerged as champions of quality and safety initiatives, offering training, resources, access to best practices, and data collection strategies to move the cause of quality.
Coding Guidelines For Evaluation And Management Services In Internal Medicine...Richard Smith
Evaluation and management (E/M) services play a crucial role in the practice of internists, and accurate coding for these visits is essential for the financial well-being of medical practice. However, determining the appropriate level of billing for an E/M code can be challenging for many physicians.
Coding Guidelines For Evaluation And Management Services In Internal Medicine...Richard Smith
Evaluation and management (E/M) services play a crucial role in the practice of internists, and accurate coding for these visits is essential for the financial well-being of medical practice. However, determining the appropriate level of billing for an E/M code can be challenging for many physicians.
Why Revenue Cycle Management Matters For RCM Healthcare Providers.pptMatthew Clark
The healthcare landscape in the United States is undergoing the significant changes, driven by factors such as evolving regulations, increasing patient expectations, and advances in medical technology. In this dynamic environment, healthcare providers are constantly striving to deliver high-quality patient care while maintaining financial stability. One crucial aspect that plays a pivotal role in achieving this delicate balance is revenue cycle management (RCM).
In a new report, SVB Analytics examines the challenges facing stakeholders in the U.S. healthcare system, the solutions made possible by technology advancements and opportunities for entrepreneurs and investors.
Learn more here: http://www.svb.com/Blogs/Alex_Lee/Digital_Health__Mapping_Digital_Health_Solutions/
Top seven healthcare outcome measures of healthJosephMtonga1
The seven healthcare outcome measures are meant to understand the quality of health systems and how they could be measured and how quality care could be provided to clients.
A Guide for Medical Billing and Coding Audits for Wound Care Providers.pdfSolemanOne
Utilizing evidence-based clinical practice guidelines, wound care practitioners can use this medical billing road map to enhance their clinical documentation and adhere to payer coverage policy and medical necessity requirements.
Predictive Analytics: It's The Intervention That MattersHealth Catalyst
In this two-part webinar, get the detailed knowledge you need to make informed decisions about adopting predictive analytics in healthcare so you can separate today's hype from reality. In part 1, you'll learn key learnings from Dale Sanders including 1) our fixation on predictive analytics in readmissions, 2) the common trap of predictions without interventions, 3) the common misconceptions of correlations verses causation, 4) examples of predictions without algorithms, and 5) the importance of putting the basics first.
In part 2, you'll hear from industry expert David Crockett, PhD in a "graduate level" crash course cover key concepts such as machine learning, algorithms, feature selection, classification, tools and more.
Healthcare IT Services Insights - January 2016Duff & Phelps
This issue of Healthcare IT Insights details the increased use of predictive analytics in the healthcare industry to reduce costs and improve outcomes for patients and populations. Predictive analytics can address three categories that unnecessarily cost the healthcare delivery system in the U.S. approximately $350 billion annually: overtreatment, care delivery failure and lack of care coordination.
CHAPTER 1 SEMESTER V PREVENTIVE-PEDIATRICS.pdfSachin Sharma
This content provides an overview of preventive pediatrics. It defines preventive pediatrics as preventing disease and promoting children's physical, mental, and social well-being to achieve positive health. It discusses antenatal, postnatal, and social preventive pediatrics. It also covers various child health programs like immunization, breastfeeding, ICDS, and the roles of organizations like WHO, UNICEF, and nurses in preventive pediatrics.
The Importance of Community Nursing Care.pdfAD Healthcare
NDIS and Community 24/7 Nursing Care is a specific type of support that may be provided under the NDIS for individuals with complex medical needs who require ongoing nursing care in a community setting, such as their home or a supported accommodation facility.
Empowering ACOs: Leveraging Quality Management Tools for MIPS and BeyondHealth Catalyst
Join us as we delve into the crucial realm of quality reporting for MSSP (Medicare Shared Savings Program) Accountable Care Organizations (ACOs).
In this session, we will explore how a robust quality management solution can empower your organization to meet regulatory requirements and improve processes for MIPS reporting and internal quality programs. Learn how our MeasureAble application enables compliance and fosters continuous improvement.
Health Education on prevention of hypertensionRadhika kulvi
Hypertension is a chronic condition of concern due to its role in the causation of coronary heart diseases. Hypertension is a worldwide epidemic and important risk factor for coronary artery disease, stroke and renal diseases. Blood pressure is the force exerted by the blood against the walls of the blood vessels and is sufficient to maintain tissue perfusion during activity and rest. Hypertension is sustained elevation of BP. In adults, HTN exists when systolic blood pressure is equal to or greater than 140mmHg or diastolic BP is equal to or greater than 90mmHg. The
PET CT beginners Guide covers some of the underrepresented topics in PET CTMiadAlsulami
This lecture briefly covers some of the underrepresented topics in Molecular imaging with cases , such as:
- Primary pleural tumors and pleural metastases.
- Distinguishing between MPM and Talc Pleurodesis.
- Urological tumors.
- The role of FDG PET in NET.
Global launch of the Healthy Ageing and Prevention Index 2nd wave – alongside...ILC- UK
The Healthy Ageing and Prevention Index is an online tool created by ILC that ranks countries on six metrics including, life span, health span, work span, income, environmental performance, and happiness. The Index helps us understand how well countries have adapted to longevity and inform decision makers on what must be done to maximise the economic benefits that comes with living well for longer.
Alongside the 77th World Health Assembly in Geneva on 28 May 2024, we launched the second version of our Index, allowing us to track progress and give new insights into what needs to be done to keep populations healthier for longer.
The speakers included:
Professor Orazio Schillaci, Minister of Health, Italy
Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum
Professor Ilona Kickbusch, Founder and Chair, Global Health Centre, Geneva Graduate Institute and co-chair, World Health Summit Council
Dr Natasha Azzopardi Muscat, Director, Country Health Policies and Systems Division, World Health Organisation EURO
Dr Marta Lomazzi, Executive Manager, World Federation of Public Health Associations
Dr Shyam Bishen, Head, Centre for Health and Healthcare and Member of the Executive Committee, World Economic Forum
Dr Karin Tegmark Wisell, Director General, Public Health Agency of Sweden
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Under Pressure : Kenneth Kruk's StrategyKenneth Kruk
Kenneth Kruk's story of transforming challenges into opportunities by leading successful medical record transitions and bridging scientific knowledge gaps during COVID-19.
Letter to MREC - application to conduct studyAzreen Aj
Application to conduct study on research title 'Awareness and knowledge of oral cancer and precancer among dental outpatient in Klinik Pergigian Merlimau, Melaka'
3. Project risks
Legal & Regulatory risks
Reputation risks
Corporate Governance risks
Business continuity risks
People risks
Supply chain risks
Technology risks
Economic risks
Social risks
MAJOR
CATEGORIES OF
RISK IN
HEALTHCARE
a KONNECTORS
presentation
A list of audit universe areas where
applications are present to better assess the IT
risks of health-care providers. Risk areas
identified* include:
•Accounts payable.
•Admissions, discharges, and transfers.
•Ancillaries.
•Billing and accounts receivable.
•Cardiology.
•Core clinical activities.
•Cost accounting.
•Decision support.
•Emergency department.
•General ledger.
•Health information management.
•Human resources.
•Laboratory.
•Materials management.
•Payroll.
•Pharmacy.
•Physician practice management.
•Radiology.
•Scheduling.
•Surgery.
The audit universe also identified general
control areas that should be examined during
the assessment. These areas include:
•Application change controls.
•Backup and recovery processes.
•Compliance initiatives.
•Disaster recovery planning efforts.
•Infrastructure configuration management
activities.
•IT management processes.
•Network infrastructure, security
administration, and server infrastructure
activities.
•System development and acquisition life
cycle initiatives.
•Third-party services.
•Data center environmental controls.
Finally, besides identifying
general control areas, the audit
universe pinpoints a number of
common IT security high-risk
areas, including Web
applications, medical devices
connected to the network,
wireless networks, and
application interfaces. Below is a
description of each high risk and
its associated audit universe
area.
Risk assessment of IT
risks in Healthcare
4. AssessingITRisksinthe
HealthcareIndustry
While the adoption of new technology offers a number of benefits and gives health-care providers the opportunity to
gain a competitive advantage, it also introduces new risks into the environment that must be managed appropriately.
Health-care providers are rapidly deploying IT systems to dramatically change business processes, create new
opportunities, and reduce costs. Because failures in health-care technology can be life threatening, internal auditors
need to become aware of the different technology-related risks in the health-care field and learn about potential audit
approaches to address identified problem areas.
As part of their work, health-care providers collect and maintain non-clinical personal information that could be used
for identity theft purposes, such as Social Security numbers and credit card and insurance account information. In
addition, many organizations are adopting automated health information systems, thus highlighting the importance of
continuous system availability and decreased downtime. Hence, data integrity remains a critical factor that is necessary
to ensure better patient care and is an area that is regulated more and more through different national and industry-
specific regulations.
Considering the different IT security risks that are affecting organizations and the technologies used in the health-care
field, where should internal auditors and organizations focus their audit activities? A good starting point is to conduct an
IT enterprise risk assessment. Ideally, this risk assessment should be revisited and updated as necessary on a continuous
basis. The Health Information and Management System Society's (HIMSS's) 18th Annual Leadership Survey provided
insight into the priorities of CIOs in the health-care sector, their areas of perceived risks, and the tools used to mitigate
those risks (refer to the 3 charts below).
a KONNECTORS presentation
5. Charge Description Master (CDM): Is the hospital reviewing this area on a regular basis to
make sure they capture charges correctly? Coding and charge information can change frequently
and if a procedure is recorded incorrectly, a hospital may not receive the correct reimbursement
amount.
Pharmacy: What system does the hospital use for medications? How are medications controlled?
How are patient accounts charged?
One day stays: What is the criterion for admissions? How is the criteria applied for medical
observation? Is the billing corrected if the criteria are not met?
Managing cash activities: How is cash accounted for? How are receipts given out? What types
of receipts are utilized? How is this information recorded into a patient’s account? Is a lock box
used to hold onto cash until deposited to a central location? How often is cash collected and
deposited? What controls are in place for cash handling and who handles the cash?
Admitting and registration of patients: When a procedure has been scheduled in advance,
how does the hospital register the patient? Does the admitting area ask for identification and
insurance information upon arrival at the hospital? Are any co-payments and deductibles discussed
prior to the procedure taking place? How are co-payments and deductibles collected?
Laboratory: Is the laboratory in compliance with OIG guidelines? Do reference forms contain all
needed diagnostic information? Is there a maximum time limit for standing orders? How does the
laboratory charge? On result only?
Charity care: Is there a process in place to maintain charity applications? Are logs maintained?
Who approves charity write-offs? Who reviews write-off codes for compliance with hospital-level
services defined by HCAP?
Miscellaneous: Are the discounts (in case of multiple services availed by a patient and available
at that time under Hospital’s policy) properly adjusted at the time of billing ?
Revenue
Assurance
in a
Hospital
a KONNECTORS presentation
On an average,
companies lost seven
percent of revenue to
fraud in 2008,
according to the
Association of
Certified
Fraud Examiners
(ACFE) 2008 Report to
the Nation on
Occupational Fraud
and Abuse.
6. PRIORITY B
Processes with significant
but less likely risks will
receive audit focus,
if they relate to or can be
efficiently audited with
other 'A' processes.
PRIORITY A
Processes with risks that
are both significant and
likely. Unless risks are well
managed, they should be
a key focus of
the audit plan.
PRIORITY C
Processes with likely but
low significant risks.
Minimal audit focus.
PRIORITY D
Minimal or no audit focus.
Human Resources;
Patient Satisfaction
Legal & Regulatory;
Contracts;
Information Systems;
Treasury
PatientServices;
RevenueCycle
Supply Chain
Management
Grant
Administration
a KONNECTORS
presentation
For the
evolving
hospital
industry,
managing
risk is
a high-stakes
business
issue.
7. Some
associated
risks
Healthcare providers & Others consists of Sample risk(s) associated with the healthcare provider & Others
Hospitals (Private/ Government) Not enough beds to accommodate all patients; whether proper billing
charged to the patients.
Nursing Homes Running without license; Either short on some medicines/ injections or a
doctor not available on duty (for any reason, in an emergency)
Testing Laboratories Personnel not available to do the testing & hence further delay in patients’
treatment.
Pharmaceutical Companies Some medicines’ supply not frequently available or very highly priced;
regulation risks.
Diagnostic Centers Some machines not working properly.
Medical Equipment (X-ray machines, BP
testing machines, CT scan machines, etc)
Manufacturers
Not able to meet the demand for the various machines from all the
customers (including hospitals/ R&D centres, etc).
Health Insurance companies/ Third Party
Administrators (TPAs)
Claim settlements; forged documents; Hospitals charging higher rates
(where mediclaim is applicable)
Colleges/ Universities/ Institutes teaching
medicine
Not able to meet the demand of the medical professionals as required.
Specialised R&D centres Breach of agreement vis-à-vis technology transfer; failure of research
resulting in writing off of expenditure incurred.
a KONNECTORS
presentation
8. Risks that
were
identified
in 2010,
were
present in
surveys of
2005 & 2007
too
Top 10 Risks 2010 *
(5 risks were present earlier too)
Level of risk
in 2007
Level of
risk in 2005
Percent of respondents
who believe that passage
of healthcare reform will
increase this risk
Estimate of an
organization’s
ability to control
this risk
Payment increases consistently below medical inflation:
potential for precipitous reductions in reimbursement as
a result of state and federal regulatory changes Top-Level Top-Level 92% Limited or none
Physician relationships: ability to control the direction
and level of alignment of physicians and institutions Top-Level Top-Level 96% Reasonable
Increased enforcement initiatives and governmental
challenge of overpayment for services (e.g. RAC, MIC,
and ZPIC audits, Stark anti-kickback statutes, false claims
laws, antitrust, etc.) Low-Level Mid-Level 89% Some
Unfunded mandates for the provision of healthcare
services Top-Level Top-Level 66% Limited or none
Increasing cost of capital and significant gap between
capital needs and capital available from all sources Low-Level Low-Level 66% Some
Top 10 Risks 2010 *
(5 new risks in 2010)
Percent of respondents
who believe that passage of
healthcare reform will
increase this risk
Estimate of an organization’s ability
to control this risk
Preparedness for clinical automation: inadequate
information technology requiring investment in more
sophisticated information systems 83% Reasonable
An extended economic recovery or a return to a
significant recessionary environment; unemployment
increases and continues to remain high No additional impact None
Improving performance in the midst of accelerating
regulatory and marketplace change 85% Reasonable
Rebuilding the organization’s balance sheet 73% Reasonable
Significant reduction in employer-based insurance 77% None
Risks that
were
identified as
new in 2010
a KONNECTORS
presentation
9. Important auditable functions/ areas from an Hospital’s perspective:
SERVICE DELIVERY Medical strategy &
service excellence
Patient reception &
admission
Diagnosis & Patient
treatment
Patient discharge &
rehabilitation
services
Medical record
maintenance
Corporate
Governance
Business Planning M & As and Projects
Marketing & Sales
Stakeholder
perspective
Cost perspective Procurement -
Medical supplies
Procurement - Capex HR & Payroll
Some other enablers
Insurance including
TPA
Housekeeping
Operating systems
& IT
Miscellaneous
Blood Bank
management
Waste & Energy
management
F&B
Legal & Taxation
Inventory
management
Customer service
a KONNECTORS presentation
10. Process/sub-process
withHighrisk
criticality
i Hospital Governance
ii Medical & Quality Audit
iii Operations Support Audit
iv People Audit
v Finance & Accounts
vi Compliance Management
Mergers & Acquisition –
Internal Control DDR
Medical Strategy & Quality
Capacity Management
Quality Compliance
Management –
NABH/ JCI
New Projects
Corporate Governance
Marketing
Hospital Governance
Compliance
Management
Medical Records
Secretarial
EHS
Other enactments
JCI standards
NABH standards
Medical & Quality Audit
Stress Care Centres
Operation Theatre’s
ICU, MICU, ICCU & PICU
Imaging Centres &
Laboratory’s
Vascular Rooms
Cardiac Recovery rooms
Preparatory room
Recovery room
Ambulance services
Surgical Services
Blood bank management
Functional audit
areas of focus
(High risk) Admissions
Procurement including CPC
Inventory Management
Discharge & Billing
Patient Safety – Incident
Management
Insurance including TPA
Bio / Non Bio Medical equipment
IT Support – FOS, ITGC, ERP,
Business Continuity & DRP
Operations Support
Audit
HR Planning & Recruitment
Employee training
Roster management
Leadership Development Initiatives
Performance Appraisal process
Employee Satisfaction Survey
People Audit
Budgeting
Accounts Receivable
Accounts Payable
Fixed Assets Management
Capital Expenditure
Taxation
Financial Reporting
Share Capital And Funds
Utilization
Finance & Accounts
a KONNECTORS presentation
11. Process/ sub-
process with
Medium risk
criticality
Medical & Quality Audit
Allied Health operations
Medical Psyh Units
Progressive Care Unit
Nurse/ Doctors bay
Pediatrics/ Ortho/ Neuro Unit
Foods & Beverages
Laundry & Housekeeping
Centre for Community Service
Autopsy & Mortuary management
Pharmacy
Energy & Water consumption
Operations Support
Audit
Hospital and clinician
relationship management
Employee Records
Payroll end to end
Salary benchmarking
People Audit
Cash & Bank Management
Treasury
Stock Options
Foreign Exchange
Investments
Share Capital And Funds Utilization
Finance & Accounts
a KONNECTORS
presentation
Risk Levels*
1. Top-Level Enterprise Risks
These risks were identified by all or virtually all of the respondents and are seen as meeting the
following parameters:
a. A current risk or one that is on the short-term horizon
b. A risk that has a high likelihood of occurring
c. A risk that is seen as having a significant impact on the healthcare system.
2. Mid-Level Enterprise Risks
These are essentially “around the corner” risks as identified by the executives. They are generally
viewed as having a lower likelihood of happening or a longer lead time. However, if the risk becomes
a reality, it is viewed as having a significant impact on the organization.
3. Lower-Level Enterprise Risks
These risks meet one or more of the following parameters:
a. Much lower likelihood of occurring or a longer timeframe for a healthcare organization to adjust
b. Less impact on the system and/or a more manageable level of risk
It may happen that low
level risks of today might
become/ shift to medium
or high category of risks,
if left uncontrolled. So,
risk management has to
be a continuous & all-
pervasive exercise.
12. 1. Does increasing
volatility and growing
complexity make risk
management central and
strategic to your entity ?
2. Do you see the risk
management capabilities
as
important to future
profitability and long-
term growth.
3. Are you implementing
comprehensive
enterprise risk
management programs?
4. Executives expect their
investments in risk
management to increase
over the next two years.
1. How active is your company
in influencing risk regulation in
your industry or geography
(e.g. establishing direction for
future industry reform)?
2. How is healthcare reform
addressed within your risk
management program?
3. How are pricing issues
addressed within the risk
management program?
4. How is capital adequacy or
the risk-bearing capacity of the
balance sheet addressed within
your risk management
program?
1. Balance risk appetite
with risk capacity.
2. Focus on supply chain
risk.
3. Improve governance
of risk & compliance.
4. Use a more holistic
approach.
Action to
achieve risk
mastery
Handling of primary
concerns for a
healthcare entity
How do you view
risk management
capabilities ?
a KONNECTORS
presentation
“ With more hospitals now hiring physicians and
acquiring physician groups, they need to rethink both
the duration and magnitude of their risk exposures.”
13. A. Look to create shareholder value from risk
management.
B. Involve the risk organization in key decision-
making processes.
C. Improve the sophistication of measurement,
modeling and
analytics to anticipate risks in an increasingly
complex environment.
D. Go beyond a compliance mindset of risk
management to deliver more complete business
solutions that drive competitive differentiation.
E. Integrate risk management capabilities across
business units and organizational structures.
F. Establish a dedicated, C-level risk executive
with oversight and
visibility across the business.
G. Infuse risk awareness across the
organizational culture.
H. Invest in continuous improvement.
a KONNECTORS
presentation
Critical Success Factors
for Effective Strategic
Risk Management
• Align your strategy with the risks most relevant to
your ability to achieve your near- and long-term
strategic objectives.
• Create an efficient organizational structure with
clear roles and responsibilities for everyone on the
team. Leverage existing functions and teams, rather
than creating more bureaucracy or overburdening
leadership with decisions and tasks that can be
handled by the rest of the team.
• Put a transparent, repeatable process in place.
Where possible, make use of existing processes to
ensure minimal disruption, and provide clear direction
and well-defined deliverables. Where new approaches
are needed, deploy strong change management
disciplines to optimize workforce involvement and
acceptance.
• Determine appropriate risk metrics and meaningful
reporting formats, and establish a process for
monitoring risk metrics to make sure information is
relevant, reliable and provided on a regular,
established basis.
• Develop and implement those tools and templates
needed to efficiently standardize and sustain the risk
management process, emphasizing practicality and
cost/benefit optimization.
14. Internal audit is a 5-step
process @ KONNECTORS.
Risk Assessment
Annual Internal Audit
Plan Development
Audit Program
Development &
Execution
Findings &
Recommendations
Monitoring of
Implementations
Step 1
Step 2
Step 4
Step 3
Step 5
a KONNECTORS presentation
1. We don’t have any risks.
2. Hopefully nothing bad happens today.
3. Everybody needs to be careful all the
time.
4. If you make a mistake, we’ll
fine/discipline/fire you!
5. We had a meeting and discussed the
chance that if a particular risk could
happen, we would communicate to
everyone.
6. We brainstormed what could happen,
and we took some actions to minimize the
chance.
7. We developed a risk assessment of our
process, and have an ongoing action plan
and cadence to address the highest
prioritized risks.
Some businesses manage
risks by the
following ways today:
15. a KONNECTORS presentation
Please Contact:
Founder Adarsh Saxena, CA
@
KONNECTORS
RMT
Solutions
konnectorsrmts.2012@gmail.com
+91-9873016166.
New Delhi - 110018.
India.
R S
K
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