2010 AHIA Northwest Regional Seminar

10:00am - 10:15am BREAK

10:15am - 11:10am Understanding Key Health System Risks - The Impact of Health Care Reform

Steven D. Huebner, Partner, KPMG LLP

Participants should understand the health care risk environment, key risks and the impact of health care reform.

Participants will receive the results of KPMG's most recent survey of health care executives which identifies key risks facing health care systems as well as the impact of reform on such risk.

11:10am - 12:00pm Changes to the IIA Standards & Implications for Healthcare Organizations

Keith Kawashima, Managing Director, West Region Internal Audit, Protiviti
Grant Baumgartner, Managing Director, West Region Healthcare Industry, Protiviti

In 2009 the Institute of Internal Auditors (IIA) released its revised International Professional Practices Framework, which includes revisions to the organization's International Standards for the Professional Practice of Internal Auditing. Key changes to the Standards include six new standards, revised wording and additional requirements to the existing Standards and the addition of interpretations incorporating components that were previously part of the IIA's practice advisories.

This session will provide a review of the changes to the Standards plus provide you with helpful examples of how to implement the changes in a healthcare organization environment.

12:00pm - 1:00pm LUNCH (provided)

1:00pm - 1:50pm Internal Audit - Adding Value

Joyce L. Lang, Director, Management Audit Services, Legacy Health

Internal auditors are continuously challenged by the Audit Committee and Executive Management to "add value" through their work. Unfortunately, there is no single answer as to what adding value means. This session will present three methods (revenue enhancement/cost saving audits, Balanced Scorecard reporting, and incorporating the new professional standards into the audit program) that several healthcare internal audit departments use to show the value they add to the organization.

1:50pm - 2:45pm Auditing the Dark Side of the EHR

Lori Laubach, Partner, Moss Adams LLP

Electronic health records (EHR) provide efficiencies for providers and staff to support accurate, complete, and timely documentation and coding for services. These types of records also provide challenges to practices as the functionality provided with the record could allow for unintended risk to the organization and lead to inaccurate coding of services provided. As in financial systems, an EHR should have internal controls to ensure the documentation supports the services provided as well as billed. Many of these controls are accessible in the background or rather the "Dark Side".

We will identify where the EHR provides the ability for complete and accurate documentation and quality patient care; but will also identify where risk is associated with specific functions in an electronic record; and examples on how to complete an internal audit of the EHR internal controls.

During our discussion of risk areas, we will link the risks or areas of concern with the HITECH guidance on meaningful use.

2:45pm - 3:00pm BREAK

3:00pm - 3:45pm An Introduction to Research Compliance

Nicole Jacobs, Research Integrity Officer, Seattle Children's Research Institute

Those in healthcare who do not work in the research compliance field are often only aware of one or maybe two aspects of research compliance, usually research billing and human subject protections. Research compliance, however, is a vast arena which encompasses much more than these two topics. This session will provide a broad introduction to the research compliance field. Participants will:
1. Obtain an overview of the seven different research compliance categories and learn about the various topics within each category.
2. Understand the structure of federal research oversight, and identify key regulations governing research.
3. Find out about current research compliance issues.

3:00pm - 3:45pm Auditing Health Plan Claims

Teri Long, Senior Audit Manager, Kaiser Permanente
Robert Thieling, Director Audit Services, Group Health Cooperative
Chrisna Meckler, Assistant Director, Regence
Steve Gasparich, System Director, Integrity, Compliance and Audit Services, Providence Health & Services

Charges for outside medical services is one of the largest expenditures incurred by any organization offering health insurance plans. With increasing pressure to reduce the cost of health care, insurers must be diligent to ensure that claims received from outside providers are paid accurately and timely. Accurate coding and payment of claims is key to building insurance rates for subsequent years, contracting with employers and other groups, and properly coordinating payments with other insurers and co-insurers. Failure to capture, adjudicate, and pay claims accurately could result in payment on fraudulent claims, increased costs, interest expenses, fines and penalties, increased regulatory scrutiny, provider dissatisfaction, and purchaser complaints.

We will focus on the end-to-end claims auditing process, including development of specific audit objectives, identification of expected controls, and testing strategies. Discussion will also include claims quality assurance reviews, recoveries and adjustments, and third party claims processing.

3:50pm - 4:40pm Auditing Pharmacy's Unit of Measure Conversion Process

Sharon Hartzel, Senior Manager, Moss Adams LLP

For many items dispensed and billed by Pharmacy, the billable dose does not correspond to the usual dose dispensed. The unit of measure conversion process is complex and presents many challenges. An ineffective process may ultimately lead to billing inaccuracies and compliance risks.

In this session we will identify the areas of greatest risk in the process to determine billable units for items dispensed by Pharmacy. For each area of risk, we will provide best practice audit techniques, including automated tools, to evaluate your system of internal control. Recommendations for improvement will also be discussed.

3:50pm - 4:40pm Tips and Tricks - Using Data Analysis to Evaluate Accounts Payable

Jodi Bennett, Senior CAAT Specialist, Providence Health & Services

Participants will learn how to use data analytics to review accounts payable and perform the following tests:

1. Perform duplicate payment tests on multiple groups of key fields; learn how to use custom fields to make duplicate testing more accurate.
2. Perform discount lost analysis that includes an aging of key dates to help identify where in the process the delay may be happening.
3. Compare the sequence of invoice numbers to the date sequence of those same invoices. This test looks for potential ghost invoicing.
4. Learn how to normalize address fields so that searches for duplicate vendor addresses or doing comparisons of the vendor address fields to other data files with addresses, such as an employee file, contain less false positives.