Will There Be a Review of the ADR Process?
Yes. The Compliance Office has engaged POIS/ITS to determine if this workflow can be improved.
Who is Responsible for Compliant Billing Through an MSA Agreement?
The organization submitting the bill or claim is responsible for the integrity of that bill or claim. Of course, the provider is ultimately responsible for any service performed and for the claims that are submitted on their behalf.
If a Department Uses an Outsource Vendor for Coding Their Claims, Can the Same Outsource Vendor Be Used for Auditing?
No. For example, if a Department is using The Coding Network for coding support, then any compliance program risk-based audit assignment of a provider in that department would be performed by the internal billing compliance staff or a different coding vendor engaged by the Compliance Office.
Will Departments Continue to Get Audited by Internal Audit? What is the Difference Between Internal Audits and CPO Audits for Clinical Compliance?
Internal Audit has a very broad range of responsibilities over WCM business operations and financial controls. Billing Compliance operations focus on professional fee billing. Departments can expect ongoing support from both Internal Audit and Billing Compliance.
Is There Any Impact to Providers That have Been Grandfathered Out of EPIC?
The Billing Compliance program encompasses all WCM providers who have professional fee billing activity regardless of where they document their patient services. Timely access to records needed for an audit is a requirement per the WCM Annual Compliance Plan.