HCRA Compliance Reviews

Provider Milestones and Timelines for Review of Four Years

Timeline Phase Description Reviewee Responsibilities
Day 1 Reviewee Notification, Review Kick-off KPMG LLP (KPMG) sends letter, questionnaire, and data requests to reviewee. The reviewee will have 44 business days to compile data requests, ask questions, and prepare documentation. KPMG will schedule on-site time for the entrance conference.
  • Assign review liaison
  • Assemble electronic data files per "blue prints" provided as part of the questionnaire process
  • Provide supporting documentation on how "Patient Service Revenue" is flagged
  • Assemble requested reconciliations as explained in the questionnaire
  • Assemble supporting documentation for prior period adjustments
  • Coordinate interviews with applicable process owners
Day 11
Day 22
Day 33
Pre-fieldwork Planning KPMG will schedule the kick-off and data pull conference calls. The kick-off conference call is held to describe the process of the review and the data pull conference call details what data fields KPMG is requesting.
  • Participate in the kick-off and data pull conference calls
  • Begin extracting the data after the data pull conference call
Day 40 Questionnaire Submission Reviewee´s completed questionnaire is due to KPMG
  • The reviewee submits a completed electronic version of the questionnaire to KPMG
Day 45 - 60 Entrance Conference/ Data Receipt/ Fieldwork Begins On Day 45, an entrance conference will be held, and the first years´ worth of data is due. Fieldwork begins on Day 45, and KPMG will be on-site at this time conducting interviews and reviewing documentation. The additional years will be due incrementally in each of the following weeks. The last day to submit requested data and documentation to KPMG is Day 60.
  • Provide KPMG with data/documentation requested
  • Review supporting documentation, electronic data files as well as the responses to the questionnaire
  • Participate in interview process
  • Provide timely responses to interview questions
  • Review meeting minutes and/or weekly status tracker
Day 45 Data and Information Request Representation Letter Due Letter indicating that all documentation and data provided to this point is complete, accurate, and in accordance with the instructions in KPMG´s questionnaire
  • Using the KPMG provided letter, please sign and provide to KPMG at the entrance conference.
Day 70 Fieldwork - Resolution of Data Issues KPMG will resolve data follow-up questions and confirm if alternative procedures are required. Testing commences at this point.
  • To the extent alternative procedures are required, the review liaison will provide timely response to the additional data request(s).
  • Respond timely to follow-up questions
Day 90 Payor Determinations Provided to Reviewee KPMG will conduct a name to name match with the claims data to the DOH electing Payor list. KPMG will identify the direct and non-direct payors. KPMG´s determinations will be provided to the reviewee for review.
  • Review KPMG determinations
  • Prepare supporting evidence for disputed results
Day 95 Preliminary Review Payor Determination Responses The reviewee will provide preliminary supporting documentation to KPMG.
  • Submit supporting evidence for disputed results to KPMG
Day 100 Preliminary Determination of Acceptable Supporting Evidence KPMG and DOH discuss the supporting documentation provided by the reviewee to determine if it is acceptable. N/A
Day 110 Responses to Payor Determinations are due to KPMG Reviewee responses and supporting documentation are due to KPMG. KPMG to review responses and discuss with DOH.
  • Submit responses to test results to KPMG project manager
  • Respond to any additional requests or questions regarding the reviewee responses
Day 130 Testing Results Sent to Reviewee KPMG will send test results to the reviewee for their review and response. KPMG, DOH, and the reviewee will hold a conference call to discuss the draft findings and next steps.
  • Review KPMG test results
  • Review weekly status tracker
Day 135 Preliminary Results Meeting A conference call between the reviewee, DOH and KPMG is held to discuss KPMG´s preliminary test results.
  • Review KPMG test results
  • Prepare supporting evidence for disputed results
Day 140 Preliminary Review Response The reviewee will provide supporting documentation to KPMG.
  • Submit supporting evidence for disputed results to KPMG
Day 145 Preliminary Determination of Acceptable Supporting Evidence KPMG and DOH discuss the supporting documentation provided by the reviewee to determine if it is acceptable. N/A
Day 155 Responses to Test Results are due to KPMG Reviewee responses and supporting documentation are due to KPMG. KPMG to review responses and discuss with DOH.
  • Submit responses to test results to KPMG project manager
  • Respond to any additional requests or questions regarding the reviewee responses
Day 170 Review of Preliminary Results Response with DOH KPMG reviews the supporting documentation provided by the reviewee and discusses with DOH. N/A
Day 180 Data Exceptions Conference KPMG, the reviewee, and DOH will engage in a conference call to discuss outstanding issues. The reviewee will be notified of the outcome of the response review, and will be given next steps. It should be noted that, once this process has been completed, the results of the testing are final.
  • Respond to any additional requests or questions regarding the reviewee responses by DOH or KPMG.
Day 205 DOH Reviews Draft Report KPMG to submit the draft report to DOH. DOH to have ten business days for report review. N/A
Day 215 KPMG Draft Report Revisions DOH report comments due to KPMG. N/A
Day 219 DOH Approves Draft Report KPMG updates the draft report based on DOH´s comments and DOH approves the draft report to be sent out to the reviewee. N/A
Day 220 Formal Response to Report KPMG to send final report to reviewee for their formal response. The reviewee to have 15 business days to formally respond to KPMG´s report, which will be included as part of the final report.
  • Prepare formal response to the report to be included in the final report
Day 225 Exit Conference A conference call is held between the reviewee, DOH, and KPMG to discuss the final report.
  • Participate in the exit conference call with DOH and KPMG
Day 235 KPMG Response to Report Reviewee´s formal response due to KPMG. KPMG to respond as necessary.
  • Submit final responses to the report to KPMG
Day 245 Final Report KPMG to submit final report with reviewee responses attached. N/A