HIPAA Risk Analysis
The Health Insurance and Portability Accountability Act (HIPAA) details the steps that covered entities must take when handling sensitive patient information, such as electronic health records. Covered entities must demonstrate compliance through written policies, as well as tangible processes, that are part of daily operations. CRI’s team members understand the aspects of entities’ responsibilities – including required policies, procedures, systems, and controls. While a successful HIPAA risk analysis identifies potential weaknesses in processes and in IT systems, our approach also pinpoints the most economical ways to mitigate the identified risks. There is no one-size-fits-all solution to improve business processes; we tailor proposed solutions to specific client needs.
Medicaid Cost Reports
Medicaid social health programs are jointly funded by the Federal and state governments, but they are ultimately managed by each state. Medicaid providers are generally required to submit cost reports that conform to each state’s reporting guidelines.
CRI is knowledgeable in the Medicaid systems of a number of states. In assisting with cost report preparation, we strive to help our clients obtain the maximum Medicaid reimbursement to which they are entitled within the laws and regulations of their state’s Medicaid system. We accomplish this goal by staying current on regulations and statutes that affect Medicaid reimbursement systems and maintaining a good working relationship with the states.
Medicare Cost Reports
Medicare-certified providers are required to submit an annual cost report to the Centers for Medicare & Medicaid Services (CMS). Cost reports contain provider information such as facility characteristics, utilization data, cost and charges by cost center, Medicare settlement data, and financial data. Applicable reports include the:
- Hospital Cost Report,
- Skilled Nursing Facility Cost Report,
- Home Health Agency Cost Report,
- Renal Facility Cost Report,
- Health Clinic Cost Report,
- Hospice Cost Report, and
- Community Mental Health Center Cost Report.
CRI has extensive experience helping clients gather necessary data and prepare cost reports. We can also aid clients in analyzing the specific costs of providing services. This analysis can enable clients to maintain positive cash flows and improve patient care.
Payroll-Based Journal Reporting
The Affordable Care Act (ACA) requires skilled nursing facilities to submit direct care staffing information based on payroll and other auditable data to the Centers for Medicare & Medicaid Services (CMS). (Note: CMS has identified staffing as one of the vital components of a nursing home’s ability to provide quality care.) CRI team members understand the Payroll-Based Journal (PBJ) reporting requirements and can assist with developing strategies to collect accurate information. We can also guide clients in implementing processes and identifying software solutions that not only satisfy compliance requirements, but also provide valuable information to foster efficiently staffed facilities.