Business System Integrity and Internal Controls. Reference: “XX-XX/RH Programs maintain processes for internal control including documentation and management encompassing patient health records, clinic visit records, billing, and remittances. XX-XX/RH Programs verify business/financial system integrity and maintain “audit readiness”. XX-XX/RH Programs verify system integrity and maintain readiness for CLIA audits/surveys: verifying that procedures, controls, and proficiency meet appropriate standards commensurate for the level of laboratory tests and properly documented.” (Page 121). Describe how this program administrative component is organized and functions. Describe the business transaction process beginning with documentation of services provided in a patient’s record, documentation on client visit record/billing sheet, documentation on billing claims (such as Medicaid). Describe how clinic visit records are used in clinic flow and retrievable for quality control reviews. [NOTE: In section 2.4, describe the internal business control process to verify that documentation is accurate and complete throughout the “chain” of documentation described in this sectin.] The Kenosha County Division of Health’s (KCDOH) Reproductive Health/Family Planning (RH-FP) clinical services Program maintains an Electronic Medical Record (EMR) system for tracking and maintaining patient health records, and clinic visit records. The initial visit creates a Patient Identification number (PID) that is used internally and throughout the billing cycle to maintain confidentiality of the client. The safeguard of the system is based on security to access; the front desk staff, Public Health Technicians, and Laboratory staff have minimal access to the EMR. They have the ability to schedule appointments, input laboratory data and view schedulers. The next level of security is the public health nurses (PHN): there are six locations access is granted dependent on roles and responsibilities of the PHN daily duties, encounter documentation, and case/patient management (i.e. home visiting (HV) nurses would not be able to view clients from the RH-FP clinic unless they “move” the client to the HV location. This would cause an alert warning and signal to the system administrator of the location move). The next level is the consultant consisting of nurse practitioners (NP)/physician assistant (PA)/medical doctor (MD) type staff level, who perform reconciliation of all RH-FP staff documentation and verification of all lab results and scanned...
Business System Integrity and Internal Controls. Reference: “XX-XX/RH Programs maintain processes for internal control including documentation and management encompassing patient health records, clinic visit records, billing, and remittances. XX-XX/RH Programs verify business/financial system integrity and maintain “audit readiness”. XX-XX/RH Programs verify system integrity and maintain readiness for CLIA audits/surveys: verifying that procedures, controls, and proficiency meet appropriate standards commensurate for the level of laboratory tests and properly documented.” (Page 121). Describe how this program administrative component is organized and functions. Describe the business transaction process beginning with documentation of services provided in a patient’s record, documentation on client visit record/billing sheet, documentation on billing claims (such as Medicaid). Describe how clinic visit records are used in clinic flow and retrievable for quality control reviews. [NOTE: In section 2.4, describe the internal business control process to verify that documentation is accurate and complete throughout the “chain” of documentation described in this sectin.] The creation of the individual client chart for all FP participants and a Client Visit Record (CVR) or billing sheet for each client visit is essential to create a “paper trail” for accurated billing procedures and accountying systems. Below describes the actual instructions on how the ONEIDA COUNTY REPRODUCTIVE HEALTH ACCOUNTING PROCEDURE is implemented:
Business System Integrity and Internal Controls. Reference: “XX-XX/RH Programs maintain processes for internal control including documentation and management encompassing patient health records, clinic visit records, billing, and remittances. XX-XX/RH Programs verify business/financial system integrity and maintain “audit readiness”. XX-XX/RH Programs verify system integrity and maintain readiness for CLIA audits/surveys: verifying that procedures, controls, and proficiency meet appropriate standards commensurate for the level of laboratory tests and properly documented.” (Page 121). Describe how this program administrative component is organized and functions. Describe the business transaction process beginning with documentation of services provided in a patient’s record, documentation on client visit record/billing sheet, documentation on billing claims (such as Medicaid). Describe how clinic visit records are used in clinic flow and retrievable for quality control reviews. [NOTE: In section 2.4, describe the internal business control process to verify that documentation is accurate and complete throughout the “chain” of documentation described in this sectin.] The business transaction process begins with documenting services in the client’s medical record. The client visit record/billing sheet is completed and signed by both the client and the Family Planning Nurse. The completed billing sheet is provided to the Health Department’s Administrative Assistant who manages the Medicaid billing claims. Client visit records are completed and signed by the client and the Family Planning Nurse. These records are currently kept in the client’s paper health record (chart). Monthly chart reviews (audits) are completed to ensure proper and complete charting. See section 2.4 for details.
Business System Integrity and Internal Controls. Reference: “XX-XX/RH Programs maintain processes for internal control including documentation and management encompassing patient health records, clinic visit records, billing, and remittances. XX-XX/RH Programs verify business/financial system integrity and maintain “audit readiness”. XX-XX/RH Programs verify system integrity and maintain readiness for CLIA audits/surveys: verifying that procedures, controls, and proficiency meet appropriate standards commensurate for the level of laboratory tests and properly documented.” (Page 121). Describe how this program administrative component is organized and functions. Describe the business transaction process beginning with documentation of services provided in a patient’s record, documentation on client visit record/billing sheet, documentation on billing claims (such as Medicaid). Describe how clinic visit records are used in clinic flow and retrievable for quality control reviews. [NOTE: In section 2.4, describe the internal business control process to verify that documentation is accurate and complete throughout the “chain” of documentation described in this sectin.] The Xxxxxx County Reproductive Health programs business transaction process starts with the client appointments scheduled and entered into our Electronic Health Record (EHR). The client arrives for their appointment and completes the appropriate visit forms. A patient visit record (PVR) form, EHR charting & a visit is completed by the Reproductive Health staff. The PVR & EHR are reviewed for completeness and accuracy with appropriate billing requirements. The clinician then e-signs and locks their client charting. The billing is generated monthly through the EHR. The insurance remittances are received and payments are posted to the correct patient accounts in the EHR. Remittance denials are reviewed, reworked and resubmitted for payment. Next the monthly general ledger reports are reviewed, and adjustments are made to the EHR with necessary updates and/or changes. Charts are periodically audited to determine compliance with our business practices. Lastly, all PVRs & remits are saved for 7 years before logged and destroyed.
Business System Integrity and Internal Controls. Reference: “XX-XX/RH Programs maintain processes for internal control including documentation and management encompassing patient health records, clinic visit records, billing, and remittances. XX-XX/RH Programs verify business/financial system integrity and maintain “audit readiness”. XX-XX/RH Programs verify system integrity and maintain readiness for CLIA audits/surveys: verifying that procedures, controls, and proficiency meet appropriate standards commensurate for the level of laboratory tests and properly documented.” (Page 121). Describe how this program administrative component is organized and functions. Describe the business transaction process beginning with documentation of services provided in a patient’s record, documentation on client visit record/billing sheet, documentation on billing claims (such as Medicaid). Describe how clinic visit records are used in clinic flow and retrievable for quality control reviews. [NOTE: In section 2.4, describe the internal business control process to verify that documentation is accurate and complete throughout the “chain” of documentation described in this sectin.] Iron County’s reproductive health program has policies and procedures in place to maintain audit readiness. Patient’s pay status (private insurance or self-pay) or Medicaid (Wisconsin and Michigan) enrollment status is monitored and documented at every visit. Assistance is provided, if needed, for enrollment or renewal in BC- FPOS. Patient visits are documented on forms provided by HCET and the WI DPH- FP/RSH/EI Program (Pregnancy/Medical Health History, Physical exam, STI Visit, etc). Using this form helps to make sure that all the required components and service elements, appropriate for the encounter, are documented clearly in the patient health care record. Additional RN notes can be found in the Progress Notes. The Client Visit Record (CVR) is used to capture the services, supplies and interventions performed during the patient encounter. The CVR also contains the correct CPT and ICD-10 codes used to prepare third party claims for reimbursement. Remittance advice is used to reconcile all third party (private insurance and Medicaid) claims.
