Centralizing audit processes for lean efficiency: real-world experiences.

Centralized audit management and lean audit processes are quickly becoming a necessity to contain rising costs. Organizations adopt these approaches to improve productivity, reduce operational expense, and mitigate risk through denial prevention. Centralized teams will be in position to conduct presubmission reviews of all documents before they go out to auditors and to capitalize on technology and data to reduce costs.

Hospitals whacked by RAC. The audit program imposes a crushing burden on hospitals. Can it be fixed?

The audit program's growing burdens are siphoning resources from patient care. Can it be fixed?

A comparative study of financial data sources for critical access hospitals: audited financial statements, the Medicare cost report, and the Internal Revenue Service form 990.

PURPOSE: Medicare cost reports (MCR), Internal Revenue Service form 990s (IRS 990), and audited financial statements (AFS) vary in their content, detail, purpose, timeliness, and certification. The purpose of this study was to compare selected financial data elements and characterize the extent of differences in financial data and ratios across the MCR, IRS 990, and AFS for a sample of nonprofit critical access hospitals (CAHs). METHODS: Line items from AFS of 47 CAHs were compared to data reported in the hospitals' MCR and IRS 990s. Line items were based on 9 financial indicators commonly used to assess hospital financial performance. FINDINGS: Of the indicators examined, the equity financing ratio most frequently matched between the 3 reports, while salaries and benefits to total expenses and debt service coverage were often different. Variances were driven by differences in individual account balances used to construct the ratios. Relative to AFS, cash was frequently lower on the IRS 990 while marketable securities and unrestricted investments were often higher. Other revenue and net income were consistently lower on the MCR and IRS 990, and depreciation was often higher on the MCR. The majority of total assets and fund balance (equity) values matched across the 3 reports, suggesting differences in classification among detailed accounts were more common than variances between the component totals (total assets, total liabilities, and fund balance). CONCLUSIONS: Health policy researchers should consider the impact of these variances on study results and consider ways to improve the availability and quality of financial accounting information.

Oversight overload: harried hospitals say the growing number of billing audits they face could actually increase costs.

Providers say the administration's growing emphasis on billing audits is pushing them to the limit and threatens to increase their costs. Many billing problems stem from simple errors, not fraud, they say. "When you get into the nuts and bolts of some of these programs you realize it's not as easy as taking the overpayment line out of the budget," says Michael Regier, of VHA.

Manual de orçamento e finanças públicas para conselheiros de saúde / Manual of appropriation and public finance for health councillor (Brazil)

O controle social, entendido como acompanhamento, fiscalização e controle das políticas públicas no Sistema Único de Saúde (SUS), possui papel fundamental na construção e no fortalecimento deste sistema universal. Isso porque a participação popular, garantida na Constituição de 1988 e incorporada pelo SUS (após a Lei Orgânica da Saúde nº 8.080/90 e nº 8.142/90), possibilitou a construção de um novo cenário na saúde, mais democrático e acessível aos brasileiros e às brasileiras. Para fomentar conhecimento e oferecer um instrumento que incentive a participação da sociedade nas políticas de saúde, inclusive nos aspectos financeiros e orçamentários, o Conselho Nacional de Saúde ­ por meio da Comissão Permanente de Financiamento e Orçamento ­ elaborou o Manual de Orçamento e Finanças Públicas para Conselheiros de Saúde, fruto de um processo de construção coletiva, e que apresenta os principais aspectos conceituais sobre o orçamento e finanças públicas. Assuntos ligados ao orçamento e finanças públicas são, por natureza, de difícil entendimento ao público e geralmente exigem atenção e explicações que facilitem o seu entendimento. A publicação do presente manual demonstra o esforço, o compromisso e a dedicação que o Conselho Nacional de Saúde tem realizado ao longo dos últimos anos na busca constante de um processo de educação permanente que qualifique conselheiros de todo o País no exercício de seu papel diante das políticas de saúde. O cenário atual é promissor e o Manual de Orçamento e Finanças Públicas para Conselheiros de Saúde certamente será uma importante ferramenta para o controle social. A realidade nos mostra que a participação de diversos atores nas Comissões de Orçamentos dos conselhos estaduais e municipais de saúde está cada vez mais consolidada. Esperamos, assim, que este Manual fortaleça sua atuação em defesa do SUS.

Medicare program; limitation on recoupment of provider and supplier overpayments. Final rule.

This final rule implements a provision of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) which prohibits recouping Medicare overpayments from a provider or supplier that seeks a reconsideration from a Qualified Independent Contractor (QIC). This provision changes how interest is to be paid to a provider or supplier whose overpayment is reversed at subsequent administrative or judicial levels of appeal. This final rule defines the overpayments to which the limitation applies, how the limitation works in concert with the appeals process, and the change in our obligation to pay interest to a provider or supplier whose appeal is successful at levels above the QIC.

Evaluación de un programa de intervención tendiente a disminuir el número de cesáreas / Assessment of an intervention program that tends to decrease number of cesareans

Introducción. En Chile se estimó una tasa de cesáreas del 40%, valor que supera lo recomendado por la organización Mundial de la Salud (OMS) (< 15%). Existen estrategias empleadas por organizaciones de salud para reducir el número de cesáreas potencialmente evitables, utilizando la auditoría médica. El objetivo del estudio fue comparar los efectos de un sistema de auditoría iniciado en 2003 sobre las tasas de cesáreas entre 1997-2002 y 2003-2005. Material y método. El análisis de auditoría se realizó utilizando la propuesta de Robson et al, asignando de forma prospectiva pacientes a una de las categorías por ellos mencionada, mediante una base de datos en File Maker 5.0 entre 2003-2005. Se comparó estos resultados con el período 1997-2002, utilizando la prueba de Chi cuadrado, considerando significativo un valor de p< 0,05. Resultados. En el grupo global de pacientes y en nulíparas no hubo diferencias estadísticamente significativas. Hubo un incremento significativo del número de cesáreas en multíparas (38,1% a 42,4%, p < 0,007), destacando un aumento en embarazo único, de término, con feto en cefálica (33,6% frente a 38,6%, p < 0,002) y en aquellas con cicatriz de cesárea previa (70,1% frente a 81,2%, p < 0,01). Destaca la reducción significativa de cesáreas en embarazo de pretérmino (56,9% a 41,3%, p < 0,000). Conclusiones. Se produjo un aumento de cesáreas en multíparas probablemente por mayor número de pacientes con cicatriz de cesárea previa y no cumplimiento del sistema de auditoría. Es importante poner en práctica el ciclo de auditoría médica para intentar prevenir que nacimientos no complicados se conviertan en complicados, aumentando así el índice de cesárea en casos "evitables"

Introduction. In Chile, the estimated cesarean section rate is 40%, much more than that recommended by the WHO (< 15%). The medical audit cycle is one of the strategies performed to reduce cesarean section rates. The objective of this study was to compare the effect of the introduction of medical audit cycle between two periods: 1997-2002 and 2003-2005. Study design. The audit analysis was conducted using the Robson et al. model, prospectively assigning patients to one of the categories mentioned by him by a data base in the File Maker 5.0 between 2003-2005. These results were compared with the 1997-2002 period, using the Chi square test (p < 0.05). Results. In the group of all women and nulliparous, there was no significant difference between the two periods. A significant increase in the cesarean rate was observed in multiparous women (38.1%-42.4%, p < 0.007) and the group of women primarily responsible for this were those with scarred uterus (70.1-81.2%, p < 0.01) and singleton, cephalic, term pregnancy (33.6%-38.6%, p < 0.002). On the contrary, we evidenced a reduction in the cesarean rate in the group singleton, cephalic preterm pregnancy (56.9%-41.3%, p < 0.000). Conclusion. The cesarean section rate in multiparous increased probably because of a greater number of women with scarred uterus and the non-fulfillment of the medical audit cycle. It is important to maintain an effective audit cycle to prevent increase in avoidable cesarean sections