New White Paper! Issued September 6, 2018
In Parternership with PYA
Linking Value-Based Purchasing to Inpatient Quality Reporting and Healthcare- Acquired Infections
It came as no surprise when the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) included Hospital Quality Reporting as a target for review in its 2017 Work Plan. The OIG’s intent was to determine to what degree the Centers for Medicare & Medicaid Services (CMS) validated Hospital Inpatient Quality Reporting (IQR) data used for the Hospital Value-Based Purchasing (VBP) and Hospital-Acquired Condition Reduction Programs (HACRP). The review indicated the need for CMS to use analytics to ensure the integrity of hospital-reported quality data and resulting payment adjustments for healthcare-acquired infection (HAI) and process-of-care measures.
Previously, hospitals were overloaded with validating all of their publicly reported quality data; however, the results of the 2017 OIG review provided hospitals with a focus area for their quality reporting compliance efforts. More than ever, organizations should plan for focused claims-based reviews, as it is necessary for them to understand how IQR data links payment to quality and enables consumers to make informed decisions about their healthcare needs. Auditors and compliance practitioners must become familiar with the current IQR measures established by CMS, as well as the Centers for Disease Control and Prevention (CDC) definition for reportable HAIs. This white paper, published by PYA and the Association of Healthcare Internal Auditors (AHIA), will provide auditors and compliance practitioners leading practice guidance for performing focused claims-based reviews to evaluate the link between IQR payment and quality.
The Association of Healthcare Internal Auditors (AHIA) is a network of experienced healthcare internal auditing professionals who come together to share tools, knowledge and insight on how to assess and evaluate risk within a complex and dynamic healthcare environment. AHIA is an advocate for the profession, continuing to elevate and champion the strategic importance of healthcare internal auditors with executive management and the Board. If you have a stake in healthcare governance, risk management and internal controls, AHIA is your one-stop resource. Explore our website for more information, www.ahia.org.
For 35 years, PYA, a national healthcare consulting firm, has helped clients navigate and derive value amid complex challenges related to regulatory compliance, mergers and acquisitions, governance, business valuations and fair market value assessments, multi-unit business and clinical integrations, best practices, tax and assurance, business analysis, and operations optimization.
PYA’s steadfast commitment to an unwavering client-centric culture has served the firm’s clients well. PYA consistently is ranked among the Top 20 healthcare consulting firms in the U.S. by Modern Healthcare. PYA’s five affiliated companies offer clients world-class data analytics, professional real estate development and advisory resources for healthcare providers, comprehensive claims audits for self-insured Fortune 500 companies, wealth management and retirement plan administration, and business transitions consulting.
PYA assists clients in all 50 states from offices in Atlanta, Kansas City, Knoxville, Nashville, and Tampa. For more information, please visit www.pyapc.com.
Copyright © 2018 Association of Healthcare Internal Auditors. All rights reserved.
AHIA white papers provide healthcare internal audit practitioners with non-mandatory professional guidance on important topics. They are intended to supplement and support the mandatory requirements of formal professional standards. By providing healthcare specific information and education, white papers can help practitioners evaluate risks, develop priorities and design audit approaches.
White Paper Subcommittee:
Chair: Alan Henton
Publications Board Liaison: Debbie Pazourek
If interested in authoring a white paper, contact Chair at email@example.com
CALL FOR WHITE PAPERS
The Association of Healthcare Internal Auditors (AHIA) is pleased to announce its Call for White Papers on topics concerning the art and science of healthcare internal auditing. A white paper is an authoritative report or guidance that informs readers concisely about a complex issue and presents the issuing body's philosophy on the matter. It is meant to help readers understand an issue, solve a problem or make a decision.
AHIA welcomes papers aimed at beginner to expert level practitioners. This includes original content clearly related to healthcare internal auditing that does not promote commercial products or services.
This is your opportunity to share your ideas, concepts, case studies, and proven methods with the AHIA healthcare internal audit community!
Submissions will be accepted on an ongoing basis…
White Paper Topics Include:
Best Practices & Case Studies
Learn best practices from the experiences of other healthcare IA practitioners. Papers in this category should provide real- life examples of implementation and lessons learned or application of various tools and models. Papers should also include specific examples of how you addressed challenges and provide measures of success.
Models in Healthcare Internal Audit
This category includes healthcare IA management theory around innovation, emerging trends, value or the future of our field.
Special Interest and Other Topics
This area provides an opportunity to address specific industries such as government, healthcare and risk management.
Specific topics of interest are listed here, but proposals with unique quality and insight on related topics will also be considered.
- Data analytics and continuous auditing (integrating with audits, describe a case study)
- Research and IRB related audits (other than typical clinical trial audits), such as grant effort reporting and expense audit procedures
- Information Technology audits (IT general controls, high risk areas)
- Accounts Receivable and Revenue Cycles
- Clinical auditing
- Credentialing- physician, general, new enrollment, etc.
- Charge capture (coding)
- 340B Drug diversion
- Auditing quality measures
- 501r implementations
To be considered for white paper development consideration, please send us your topic idea and meet the following requirements:
- Submitted via email to firstname.lastname@example.org – Subject Line – WHITE PAPER SUBMISSION
- Authors must include an abstract accurately summarizing the topic and focus of the paper (approximately 100-200 words) and author’s bio (approximately 75 words).
- Content must be structured clearly and provide an introduction (executive summary), results and observations, and conclusion.
- Content should be technically correct and be of interest to a wide audience of healthcare IA practitioners.
- Submissions cannot be previously published in their current or similar form.
- Submission that are commercial in tone and/or intended to be promotional in nature will not be considered.
- All ideas must be submitted in English.
All submissions will be reviewed by the White Paper Subcommittee composed of AHIA members. The Subcommittee will vet each idea submission. Upon acceptance, we will be in touch to work with you on the development of the White Paper in collaboration with the subcommittee. Authors/Contributors must permit AHIA to publish papers across various channels. Any written content including graphics and images from third parties must have written permission for use.
Links to existing white papers:
New White Paper! Issued September 6, 2018
Pharmacy Related Risk Areas (Deloitte/AHIA):
- Controlled Substances: Identifying Risks and Internal Audit Focus Areas
- Computerized Physician Order Entry: Identifying Risks and Internal Audit Focus Areas
- 340B Drug Discount Program and Documentation: Identifying Risks and Internal Audit Focus Areas
- Documentation, Coding, Charging and Billing for Medications: Identifying Risks and Internal Audit Focus Areas
Auditing and Monitoring White Papers (HCCA/AHIA)
- Article #1: A&M In Healthcare Organizations
- Article #2: Compliance Risk Assessment
- Article #3: Compliance Work Plan
- Article #4: CAATS
- Article #5: Documented Comprehensive Approach
- Article #6: Core Set Policies & Procedures
- Article #7: Compliance Training
- A&M Focus Group Progress Report
- Contrasting Roles and Responsibilities - Corporate Compliance and Internal Audits
- Defining the Meaning of 'Auditing' and 'Monitoring' & Clarifying the Appropriate Use of the Terms
- Physician Contracting
- Roles and Responsibilities - Corporate Compliance and Internal Audit
- Seven Component Framework