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Compliance office reports billing/coding benchmarks, vendor exclusions and 340B savings targets
Summary
Chief compliance officer Christy Lewis reported that billing/coding benchmarks exceed 95%, vendor/provider exclusion checks cleared 218 providers, hotline complaints have been remediated and the board was told the 340B program has recouped about $500,000 with an $800,000 target.
Christy Lewis, chief compliance officer, presented the compliance committee’s quarter report to the Hospital Authority Board, summarizing internal controls, audit results and program compliance measures.
Key compliance metrics included revenue-cycle coding benchmarks (inpatient 96%, outpatient 97%, DRG coding 94.8%), monthly vendor and provider exclusion screening (218 providers submitted and checked), and hotline incident reporting (three reports in the period; two substantiated and remediated within 12 and 15 days, one remaining nearly resolved). Lewis said the compliance work plan is about 44% complete for the year and emphasized ongoing automation and vendor partnerships to streamline processes.
On 3 40 b compliance, Lewis said the board-approved partnership and compliance efforts have recouped about $500,000 in savings to date and are on target to recover $800,000. She said the compliance team is expanding the program to capture prescriptions filled outside the hospital to increase 3 40 b revenue.
Lewis also flagged open litigation matters summarized for the board (breach of contract, medical malpractice, slip-and-fall, personal injury, investigation and an EEOC case) and noted that quality surveys produced mostly closed findings, with one conditional finding reopened by the Department of Health for further investigation.
Board members thanked Lewis and committee leadership for the in-depth report and the committee’s recent reengagement after a pause.
