HPE Orientation Audit Touch Points - PowerPoint Presentation

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HPE OrientationAudit Touch Points

Christopher T. Clarke, PhD, FACHE

Chief Financial & Informatics Officer

&

Cynthia M. Miller, Deputy CFO

What, Me Worry?

Nobody Likes and Audit!

No Worries just preparation

“Give me six hours to chop down a tree and I will spend the first four sharpening the axe.” 

Abraham Lincoln

Adopting the right attitude can convert a negative stress into a positive one.

Hans Selye

No Small Thing – Your Clinical Trainee Budget

2018

2019

2020

2017

Budget

Approved

AdvanceRevisedAdvanceDescriptionActualEstimate BudgetApprop. RequestApprop.Obligations [Total]$2,118,345 $1,920,756 $2,071,918 $1,999,009 $2,028,040 $2,163,137 Education & Training Support$1,208,609 $935,378 $986,000 $973,188 $994,815 $1,074,681 Education & Training Trainees$230,857 $229,299 $279,921 $210,623 $232,250 $251,111 Graduate Medical Education Trainees$678,879 $756,079 $805,997 $815,198 $800,975 $837,345

Education & Training Total

Includes Veterans Choice Act Sec. 801 and Veterans Choice Program

(dollars in thousands)

Increased OIG Interest In the end the DEO is Responsible

“As a result, the

Designated Education Officer (DEO)

did not establish required local policies and procedures for resident educational activity record keeping, monitoring resident participation in educational activities, and reconciling educational activity records with invoices submitted by the University of XXXX College of Medicine (the medical school).”

A well run process relies onSymbiotic Responsibilities

DA Process

Audit Touch PointsMajor Processes and ResponsibilitiesSlide 1 of 2

Process

Responsible Party(s)

From Handbook 1400.05

Annual Program Planning

DEO, COS, DIO

Impacts program quality & accuracy of filled-paid positions

Rate Schedule Submission(s) to OAA

DEO, CFO and Affiliate Fiscal

Minimum Annually by July 1

st; any time rates changeEstablishment and updating Local DA Policies & ProceduresMCD, COS, DEOUsed for governance, training staff and audits – must reflect national policyAnnual Internal AuditMCD appoints independent teamAssures Program is compliant with local DA policy, reveals deficiencies for program improvement

Audit Touch PointsMajor Processes and ResponsibilitiesSlide 2 of 2

Process

Responsible Party(s)

From Handbook 1400.05

Establishment of proper control points & fund tracking

CFO

Tracking by N&E Codes, only OAA funds used, proper use of 1358 & BOC

Resident VA Rotation Scheduling and Updates

DEO, COS, VA Site Directors, Affiliate Residency Program Directors

Annual and Updates? Close communication between affiliate and VA?

Resident Activity Tracking & Time Certification (must use VA Records not Affiliate)COS, DEO, VA Site Directors“When they are at the VA we can pay them, when they aren’t, we can’t” – Grant Cannon, DEO SLCInvoice ReconciliationDEO, CFO, Affiliate Residency Program Director and CFOInvoices corrected based on approved daily rates & activity/hours. Timely/Accurate Invoice PaymentCFO, Affiliate Fiscal StaffSubmission using Tungsten, certified after reconciliationAccurate and Timely Quarterly Needs and Excess ReportingCFO, DEOUsed to request additional or return excess funding

Knowledge You Can UseCynthia Miller

This Photo

by Unknown Author is licensed under

CC BY-SA

Field/OAA Fiscal Timelines

Sept – OAA releases the upcoming FY’s Target Allowance (Trainee Funding) to VHA Fiscal Service

Oct – VHA Finance Office releases the quarterly Target Allowance to VAMCs

(depending on Congress, i.e., budget impacts, Finance’s release of funds could be delayed)

Dec – Needs/Excess (1

st

qtr

).

March – begin submitting updated Rate Schedules and Stipend Memos

March – Needs/Excess (2nd qtr)June – Needs/Excess (3nd qtr)July – New Academic Year (position starts)mid-July to early August – Needs/Excess (4th qtr)This NE call is early due to VACO Fiscal Service changes in cut-off times. This will result in you having to work with the affiliates to ‘estimate’ the 4th qtr bills.

Six Definitions & Key Processes

Disbursement Agreement (2 Kinds – Submitted On-line)

“What It’s Not”

– a Contract“What It Is” – a payroll mechanism by which VA allows a “disbursing agent” to centrally administer salary payments and fringe benefits for physician and dental residents assigned to a VA medical facility.

Disbursing Agent – pays salary and benefits (can be same as sponsoring institution, not always)

Rate Schedule

Stipend Letter

Needs and Excess Report (Submitted On-line)

Disbursement Agreements(Timing of the Payments)

Payment in Advance

VA agrees to pay up to 80% of estimated charges in advance in each quarter.

Payment in Arrears

VA agrees to reimburse the Disbursing Agent based upon receipt of a properly prepared invoice and reconciliation against VA records.

The frequency of payment is monthly or quarterly.

Rate Schedules

Rate Schedules are used to:

Determines the legal daily rate to pay residents

Analyze Needs/Excess requests.The DAILY RATE MUST be used to Verify Invoices and estimate costs

Rate Schedules must be updated at least annually

.

Even if Rates have not changed;

Updates for next AY: begin January – end of June;

Must be updated any time rates change

;

VA matches Affiliate – Updates come from Affiliate

Rate Schedules Submissions

Usually DEO (CFO in the loop) responsibility to review and negotiate with affiliate before submission to OAA;

Do not simply pass the affiliate rates on to OAA without a review;

Do not ask or allow affiliate to submit to directly OAAUse OAA Template# of AL days, Affiliate and Disbursing Agent must be on rate schedule

Best if Benefits are itemized and not estimated by %

What is NOT allowed:

Affiliate administrative expenses (see ECC for these) or

Any items or funding that become property of Resident

Resident Travel (may use local funding, see Handbook 1400.09)

Meals

Housing

Stipend Letters

For Medical (260), Dental (174) and Chief Residents (8.5)

Always for Trainees paid by the VA

These Programs are often accredited in the name of VAUses “Index Program” to determine Annual SalaryUses VA Benefits

OAA only approves annual salary

Salary cannot be inflated to compensate for affiliate benefits

Needs and Excess Reporting

Used as a mechanism to reconcile differences that occur from OAA “

Initial Target Allowance

” Funding;Reported Quarterly (On-line) – Negative Replies Required;

Analyzed by OAA before approval;

Reported by Fiscal but DEO should be involved and approve;

Must use proper needs/excess code for that program.

Fiscal Budget Reports You Can Use

Current Funding Allocations

:

Medical Care Specific Purpose Funds - Current Funding Allocationshttp://vaww.oaa.med.va.gov/DBReports/NeedsandExcessCurrentAllocations.aspx/

Needs and Excess Expenditures:

Facility Requested Needs and Excess Report

http://vaww.oaa.med.va.gov/DBReports/NeedsandExcess.aspx/

http://vaww.oaa.med.va.gov/DBReports/NeedsExcessByProgram.aspx/

Disbursing Agent Rate Schedules by Year/Facility (Multiple pages)

http://vaww.oaa.med.va.gov/DBReports/disbDisbursingReport.aspx

Associated Health Locality Based Stipend Rates by Facility & Programhttp://vaww.oaa.med.va.gov/DBReports/LocBasedStipends.aspxhttp://vaww.oaa.med.va.gov/DBAHealth/RptBaseStipendV2.aspx/Associated Health & Nursing Funding Allocation Planhttp://vaww.oaa.med.va.gov/DBAHealth/ahRptAllocPlan1.aspx/

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