RECORDS AND AUDIT PROVISIONS. ON-SITE AND OFF-SITE REVIEWS/AUDITS
RECORDS AND AUDIT PROVISIONS. 5.1 ON-SITE AND OFF-SITE REVIEWS/AUDITS The IOP grants the Director, DHA [or authorized representative(s)], the right to conduct on-site or off-site reviews or accounting audits with full access to patients and records. The audits will be conducted on a scheduled or unscheduled (unannounced) basis. This right to audit/review includes, but is not limited to, the right to: (a) Examine fiscal and all other records of the IOP which would confirm compliance with this agreement and designation as an authorized IOP provider. (b) Conduct audits of IOP records including clinical, financial, and census records to determine the nature of the services being provided, and the basis for charges and claims against the United States for services provided to beneficiaries. The Director, DHA, or a designee shall have full access to records of both TRICARE and non-TRICARE patients. Note: In most cases, only TRICARE patients’ records will be audited. Examples of situations where non-TRICARE patient records would be requested may be in situations of differential quality of care assessments or to identify systemic quality and safety concerns. (c) Examine reports of evaluations and inspections conducted by federal, state, local government, and private agencies and organizations. (d) Conduct on-site inspections of the facilities of the IOP and interview employees, members of the staff, contractors, board members, volunteers, and patients, as required. (e) Release copies of final review reports (including reports of on-site reviews) under the Freedom of Information Act (FOIA).
RECORDS AND AUDIT PROVISIONS. 5.1 ON-SITE AND OFF-SITE REVIEWS/AUDITS The SUDRF grants the Deputy Director, TMA or authorized representative(s), the right to conduct on-site or off-site reviews or accounting audits with full access to patients and records. The audits may be conducted on a scheduled or unscheduled (unannounced) basis. This right to audit/ review includes, but is not limited to the right to:
(a) Examine fiscal and all other records of the SUDRF that would confirm compliance with this agreement and designation as a TRICARE-authorized provider.
(b) Conduct audits of SUDRF records, including clinical, financial, and census records to determine the nature of the services being provided and the basis for charges and claims against the United States for services provided to TRICARE beneficiaries. TMA or a designee shall have full access to records of both TRICARE and non-TRICARE patients.
(c) Examine reports of evaluations and inspections conducted by federal, state, local government, and private agencies and organizations.
(d) Conduct on-site inspections of the facilities of the SUDRF and interviewing employees, members of the staff, contractors, board members, volunteers, and patients, as may be required.
(e) Release copies of final review reports if requested under the Freedom of Information Act.
RECORDS AND AUDIT PROVISIONS. ON-SITE AND OFF-SITE REVIEWS/AUDITS The OTP grants the Director, DHA [or authorized representative(s)], the right to conduct on-site or off-site reviews or accounting audits with full access to patients and records. The audits may be conducted on a scheduled or unscheduled (unannounced) basis. This right to audit/review includes, but is not limited to, the right to: (a) Examine fiscal and all other records of the OTP which would confirm compliance with this agreement and designation as an authorized OTP provider.
RECORDS AND AUDIT PROVISIONS. 5.1 ON-SITE AND OFF-SITE REVIEWS AND AUDITS The BC grants the Director, DHA [or authorized representative(s)], the right to conduct quality assurance audits or accounting (record) audits with full access to patients and records. The audits may be conducted on a scheduled or unscheduled (unannounced) basis. This right to audit and/or review includes, but is not limited to:
(a) Examine fiscal and all other records of the BC which would confirm compliance with this agreement and designation as an authorized TRICARE BC provider.
(b) Conduct such audits of BC records including clinical, financial, and census records, as may be necessary to determine the nature of the services being provided, and the basis for charges and claims against the United States for services provided TRICARE beneficiaries.
(c) Examine reports of evaluations and inspections conducted by federal, state, local government, and private agencies and organizations.
(d) Conduct on-site inspections of the facilities of the BC and to interview employees, members of the staff, contractors, board members, volunteers, and patients, as may be required.
RECORDS AND AUDIT PROVISIONS. ON-SITE AND OFF-SITE REVIEWS/AUDITS The SUDRF grants the Director, DHA or designee, the right to conduct on-site or off-site reviews or accounting audits with full access to patients and records. The audits will be conducted on a scheduled or unscheduled (unannounced) basis. This right to audit/review includes, but is not limited to the right to: (a) Examine fiscal and all other records of the SUDRF that would confirm compliance with this agreement and designation as a TRICARE-authorized provider.
RECORDS AND AUDIT PROVISIONS. 4.1 ON-SITE AND OFF-SITE REVIEWS/AUDITS The hospice program grants the Deputy Director, TMA, or his designee the right to conduct quality assurance audits or accounting (record) audits with full access to patients and records. The audits may be conducted on a scheduled or unscheduled (unannounced) basis. The right to audit/ review includes, but is not limited to:
(a) Examination of fiscal and all other records of the hospice program which would confirm compliance with this agreement and designation as an authorized TRICARE hospice provider.
(b) Audits of hospice program records including clinical, financial, and census records to determine the nature of the services being provided, and the basis for charges and claims against the United States for services provided TRICARE beneficiaries. TMA or a designee shall have full access to records of both TRICARE and non-TRICARE patients.
(c) Examination of reports of evaluations and inspections conducted by federal, state, local government, and private agencies and organizations.
4.2 RIGHT TO UNANNOUNCED INSPECTION OF RECORDS
(a) TMA, or its designee, shall have the authority to visit and inspect the hospice program at all reasonable times on an unannounced basis.
(b) The hospice program’s records shall be available and open for review by TMA during normal working hours (8am to 5pm, Monday through Friday) on an unannounced basis.
RECORDS AND AUDIT PROVISIONS. 6.1 ON-SITE AND OFF-SITE REVIEWS/AUDITS The RTC grants the Executive Director, TMA or authorized representative(s), the right to conduct on-site or off-site reviews or accounting audits with full access to patients and records. The reviews or audits may be conducted on a scheduled or unscheduled (unannounced) basis. This right to audit/review includes, but is not limited to, the right to:
(a) Examine fiscal and all other records of the RTC that would confirm compliance with this agreement and designation as a TRICARE/CHAMPUS-authorized RTC provider.
(b) Conduct audits of RTC records, including clinical, financial, and census records to determine the nature of the services being provided and the basis for charges and claims against the United States for services provided to TRICARE/CHAMPUS beneficiaries. TMA or a designee shall have full access to records of both TRICARE/CHAMPUS and non- TRICARE/CHAMPUS patients.
(c) Examine reports of evaluations and inspections conducted by federal, state, local government, and private agencies and organizations.
(d) Conduct on-site inspections of the facilities of the RTC and interview employees, members of the staff, contractors, board members, volunteers, and patients, as may be required.
(e) Release copies of final review reports (including reports of on-site reviews) under the Freedom of Information Act.
RECORDS AND AUDIT PROVISIONS. 6.1 ON-SITE AND OFF-SITE REVIEWS/AUDITS The PHP grants the Deputy Director, TMA [or authorized representative(s)], the right to conduct on-site or off-site reviews or accounting audits with full access to patients and records. The audits may be conducted on a scheduled or unscheduled (unannounced) basis. This right to audit/ review includes, but is not limited to, the right to:
(a) Examine fiscal and all other records of the PHP which would confirm compliance with this agreement and designation as an authorized PHP provider.
(b) Conduct audits of PHP records including clinical, financial, and census records to determine the nature of the services being provided, and the basis for charges and claims against the United States for services provided to beneficiaries. The Deputy Director, TMA, or a designee shall have full access to records of both TRICARE and non-TRICARE patients.
(c) Examine reports of evaluations and inspections conducted by federal, state, local government, and private agencies and organizations.
(d) Conduct on-site inspections of the facilities of the PHP and interview employees, members of the staff, contractors, board members, volunteers, and patients, as may be required.
(e) Release copies of final review reports (including reports of on-site reviews) under the Freedom of Information Act.
RECORDS AND AUDIT PROVISIONS. ON-SITE AND OFF-SITE REVIEWS/AUDITS The IOP grants the Director, DHA [or authorized representative(s)], the right to conduct on-site or off-site reviews or accounting audits with full access to patients and records. The audits will be conducted on a scheduled or unscheduled (unannounced) basis. This right to audit/review includes, but is not limited to, the right to: (a) Examine fiscal and all other records of the IOP which would confirm compliance with this agreement and designation as an authorized IOP provider.
