Policies
Monitoring & Corrective Actions
A key element in an effective compliance program is to conduct internal monitoring to assure compliance with rules and regulations and identify areas of improvement.
±«Óãtv Health is committed to accurate billing of healthcare services provided by its credentialed providers. Risk-based monitoring is conducted based on a quarterly internal risk assessment for identified vulnerabilities, such as provider billing profile outliers, services with high utilization or targeted review by state/federal payers/agencies, denial trends, new codes or areas of concern identified by internal processes/workflows.
When errors are identified through the monitoring process, corrective action may include:
- improving charge capture and billing processes;
- educating faculty and other employees on pertinent regulations;
- and making billing corrections, as warranted, which may include refunding overpayments received as a result of the billing errors.
Monitoring reports and respective corrective actions are shared with senior leadership and compliance oversight committees on a periodic basis.