Policies
Monitoring & Corrective Actions
A key element in an effective compliance program is to conduct internal monitoring to assure compliance with rules and regulations and identify areas of improvement.
USF Health is committed to accurate billing of healthcare services provided by its credentialed providers. Risk-based monitoring is conducted based on a quarterly internal risk assessment for identified vulnerabilities, such as provider billing profile outliers, services with high utilization or targeted review by state/federal payers/agencies, denial trends, new codes or areas of concern identified by internal processes/workflows.
When errors are identified through the monitoring process, corrective action may include:
- improving charge capture and billing processes;
- educating faculty and other employees on pertinent regulations;
- and making billing corrections, as warranted, which may include refunding overpayments received as a result of the billing errors.
Monitoring reports and respective corrective actions are shared with senior leadership and compliance oversight committees on a periodic basis.