|
FY 20?? Internal Audit Plan | ||||||
|---|---|---|---|---|---|---|
|
Corporate | ||||||
|
Description of Auditing Activity |
Risk |
Frequency |
Sample Size |
Locations |
Assigned To |
Date Completed |
|
Wounds and Falls Audit |
Inaccuracy of documentation and reporting |
Annual |
5 wound and 5 fall residents |
Top 10 wound facilities & top 10 fall facilities | ||
|
Credit Balance Audit |
Inappropriate billing, False Claims, 60-Day Repayment Rule |
Annual |
10% of total dollars |
N/A | ||
|
Accuracy of Survey Data |
Inaccurate reporting of CMP's and F-Tag's |
Annual |
All annual survey's for selected facilities |
All facilities that have had a 2018 annual survey | ||
|
Wrongful Discharges |
Increase in legal fees and claims/lawsuits |
Annual | ||||
|
Skilled Nursing Facilities | ||||||
|
Description of Auditing Activity |
Risk |
Frequency |
Sample Size |
Locations |
Assigned To |
Date Completed |
|
Skilled/Medical Necessity Clinical Audits |
False Claims |
Quarterly |
5 residents RU> 30 days |
5 facilities | ||
|
Resident Trust Fund Monitoring & Follow-Up |
Misappropriation of Funds |
Monthly |
100% |
All | ||
|
Purchase Card Monitoring & Follow-Up |
Misappropriation of Funds |
Monthly |
100% |
All | ||
|
Net Revenue Testing |
Inappropriate billing, False Claims |
Quarterly |
10% of census for prior 2 months billed |
2-3 facilities | ||
|
Resident Trust Fund Testing |
Misappropriation of Funds |
Quarterly |
2 months |
2-3 facilities | ||
|
Purchase Card Testing |
Misappropriation of Funds |
Quarterly |
2 months |
2-3 facilities | ||
|
Preadmission Screening & Resident Review (PASRR) |
Federal Requirement |
Quarterly |
10% of census for prior 2 months billed |
2-3 facilities | ||
|
Census Balancing |
Inappropriate billing |
Quarterly |
2 months |
2-3 facilities | ||
|
QAPI Meeting Minutes |
Survey requirements and process improvement |
Quarterly |
2 months |
2-3 facilities | ||
|
Home Health | ||||||
|
Description of Auditing Activity |
Risk |
Frequency |
Sample Size |
Locations |
Assigned To |
Date Completed |
|
Medical Necessity Audits |
False Claims |
Annual |
10% |
All | ||
|
Physician Enterprise | ||||||
|
Description of Auditing Activity |
Risk |
Frequency |
Sample Size |
Locations |
Assigned To |
Date Completed |
|
Coding Audit |
Inappropriate coding, billing, False Claims |
One time |
Will review with External Auditor |
All | ||
|
Rehabilitation Company | ||||||
|
Description of Auditing Activity |
Risk |
Frequency |
Sample Size |
Locations |
Assigned To |
Date Completed |
|
Skilled/Medical Necessity Audits |
False Claims |
Quarterly |
5 residents RU> 30 days |
5 facilities | ||
|
Information Technology | ||||||
|
Description of Auditing Activity |
Risk |
Frequency |
Sample Size |
Locations |
Assigned To |
Date Completed |
|
IT Penetration Audit |
Security, Data Breach, HIPAA |
One time |
Will review with External Auditor |
All | ||
Resource: Sample Internal Audit Plan
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