2012-08-01
Streamlined regulatory compliance through continuous auditing
“Working with ACL technology has elevated our reputation as a trusted resource. The internal audit group is increasingly viewed as a business partner that adds significant value to the organization.”
Brantley Synco, Director of Audit Services, Baptist Health System, Inc.
Baptist Health System, Inc. (BHS) is one of the largest health care systems in Alabama and one of the state’s largest employers. BHS is a not-for-profit, 501(c) corporation that owns and manages four hospitals in the state of Alabama. Founded in Birmingham in 1922 by a group of Baptist congregations, BHS has approximately 4,300 employees in addition to almost 500 credentialed physicians.
The BHS internal audit team was already proficient with ACL audit analytics, which allowed them to gather data from multiple sources for automated analysis. Recently, BHS upgraded to a continuous auditing solution, ACL Analytics Exchange, which enables auditors to schedule data extractions, conduct routine analyses, and automate reporting. The server-powered solution runs in the middle of the night and the reports are waiting for the team to review in the morning.
BHS must adhere to multiple government regulations and provisions related to payments to physicians.
To ensure compliance with government provisions, the BHS audit team was performing lengthy on-site audits at each of its four hospitals, analysing payments made to physicians during the previous 12-18 months. Each audit took between 6-8 weeks to complete and would pinpoint issues that occurred at least a full year earlier. The team was eager to monitor control measures implemented when physician contracts were first established and approved. If BHS attorneys had correctly written each contract, subsequent payments based on those agreements should ultimately be accurate.
Using ACL technology, the audit team joined the physician contracts database with Accounts Payable files to create a series of eight monitoring reports. The automated routines run monthly to analyse payments made in the preceding 30 days. The team then issues a report before the first day of the following month. Now, anomalies such as payments made to a physician with an expired contract, are investigated in a timely manner. On-site audits that previously required 36 weeks of full-time labor are completed in just four days each month, for a total of 48 days annually.
“The ACL technical support team is terrific. I send a question by email and before I can even get a cup of coffee, the phone is ringing and they have the answer.”
Brantley Synco, , Director of Audit Services, Baptist Health System, Inc.
The BHS team has implemented additional analytics that run on a regular basis. An AP suite looks for duplicate invoices, invoices created before P.O. dates, employee refunds, vendor-employee address matches, and further red flags in the data. Other analytics target the employee master file; analyse clinic data for payments made to non-standard vendors; and scan employees, vendors, service providers and physicians against the excluded parties database maintained by the Office of the Inspector General, U.S. Department of Health & Human Services.
The BHS auditors often turn to the ACL customer support team when they have a question or technical challenge. Once a query is sent, the answer often comes back in mere minutes. Several team members have also taken ACL training courses and use the reference materials if they hit a roadblock.
Baptist Health System has applied ACL technology to:
With an ACL continuous auditing solution, the small BHS audit team can quickly access the data they need, regardless of format, system or platform. Data extractions run during off-peak hours and serverpowered analysis ensures that reports are quickly available for further investigation.
Automating the BHS physician compliance audits has been one of the team’s most successful projects to date. The on-site audits required hundreds of staff hours to complete and could only identify issues that had occurred between 12 and 18 months in the past. With automated analyses now running just 30 days after payments, it is easier to make prompt adjustments.
In AP, the ACL analytics immediately pinpoint anomalies, while serving as a deterrent against inappropriate activities. Widespread knowledge that BHS tests every transaction and has strong internal controls is a powerful weapon against fraud.
The auditors’ strong results with ACL have been extremely well received by senior management. Most importantly, the internal audit group is now seen as a company-wide resource, and a business partner that is adding significant value to the organisation.
The audit team plans to automate Recovery Audit Contractor (RAC) billing audits, which CMS conducts regularly to identify and mitigate overpayments to providers. The team will implement analytics designed to identify potential issues before a RAC audit even begins.
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