HCRA Compliance Reviews
Payor Milestones and Timelines for Review of One Year
Timeline | Phase | Description | Reviewee Responsibilities |
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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. |
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Day 11 Day 22 Day 33 |
Pre-fieldwork Planning | KPMG will schedule a series of status calls and/or on-site visits with the Reviewee to discuss:
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Day 40 | Questionnaire Submission | Reviewee´s completed questionnaire is due to KPMG |
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Day 45 | Entrance Conference/ Data Receipt/ Fieldwork Begins | On Day 45, an entrance conference will be held, and one years' worth of data is due. The last day to submit requested data and documentation to KPMG is Day 45. Fieldwork begins on Day 45, and KPMG will be on site at this time conducting interviews and reviewing documentation. |
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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. |
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Day 50 | Fieldwork - Resolution of Data Issues | KPMG will resolve data follow up questions and confirm if alternative procedures are required. Testing commences at this point. |
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Day 75 | Testing Results Sent to Reviewee | KPMG will send the Preliminary Results Packet to the Reviewee for their review and response. KPMG and the Reviewee will have a meeting to briefly discuss the preliminary findings and next steps. The Reviewee will have 22 business days to formulate and document their response to KPMG´s results. |
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Day 78 | Preliminary Results Meeting | DOH, KPMG, and Reviewee will have a meeting to discuss preliminary findings and next steps. |
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Day 81 | Preliminary Review of Responses to Test Results | On Day 81, a meeting will be held with KPMG, DOH, and the Reviewee to discuss sample(s) of supporting evidence prepared by the Reviewee to clear KPMG´s preliminary results. |
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Day 84 | Preliminary Determination of Acceptable Supporting Evidence | KPMG and DOH will meet to discuss the sample(s) of supporting evidence. DOH will determine whether the supporting evidence is acceptable. |
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Day 87 | Communicate Preliminary Determination to Reviewee | KPMG, DOH, and the Reviewee will have a meeting to communicate DOH´s preliminary determination of whether sample(s) of supporting evidence provided on Day 81 is acceptable. |
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Day 90 | Preliminary Review of Responses to Test Results | On Day 90, a second meeting will be held with KPMG, DOH, and the Reviewee to discuss sample(s) of supporting evidence prepared by the Reviewee to clear KPMG´s preliminary results. |
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Day 93 | Preliminary Determination of Acceptable Supporting Evidence | KPMG and DOH will meet to discuss the sample(s) of supporting evidence. DOH will determine whether the supporting evidence is acceptable. |
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Day 96 | Communicate Preliminary Determination to Reviewee | KPMG, DOH, and the Reviewee will engage in a conference call to communicate DOH´s preliminary determination of whether sample(s) of supporting evidence provided on Day 90 is acceptable. |
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Day 99 | Responses to Test Results are due to KPMG | Reviewee responses and supporting documentation are due to KPMG. |
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Day 102 | Review of Preliminary Results Response with DOH | KPMG will review responses and supporting documentation with DOH during the Review of Preliminary Results Response Meeting. | N/A |
Day 129 | Data Exceptions Conference | KPMG, the Reviewee, and DOH will engage in a conference call to discuss final results of testing. The Reviewee will be notified of the outcome of the response review, and will be given next steps. It should be noted the results of testing are final. |
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Day 134 | Extrapolation Process | To the extent a statistical sample is used, KPMG will send the results of testing to its statistician for extrapolation. | N/A |
Day 159 | DOH Reviews Draft Report | KPMG to submit the draft report to DOH. DOH to have 10 business days for report review. | N/A |
Day 169 | KPMG Draft Report Revisions | DOH comments on report due to KPMG. | N/A |
Day 173 | DOH Approves Draft Report | KPMG to provide revised draft report to DOH for final approval prior to delivery to the Reviewee. | N/A |
Day 174 | Formal Response to Report | KPMG to send draft 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. |
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Day 179 | Exit Conference | KPMG, the Reviewee, and DOH will engage in a conference call to discuss the report. |
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Day 189 | KPMG Response to Report | Reviewee´s response due to KPMG |
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Day 199 | Final Report | KPMG to submit final report with Reviewee responses attached. | N/A |