Waukesha County is Wisconsin’s third largest, with a population of over 383,000 residents and a total budget of almost $270 million. The county, through the Department of Health and Human Services (DHHS), provides a wide range of confidential services designed to enhance the physical and emotional functioning of individuals and families. The agency provides and coordinates prevention, intervention, and protective services in response to public needs and mandates. Often DHHS is a provider of last resort to some of the county’s most vulnerable and disadvantaged residents, and its services help individuals and families positively respond to life’s challenges, problems, and crises.

Situation

A wide range of rules and regulations complicate billing and collections for DHHS services. Given the risk and criticality of these processes, DHHS was selected by Waukesha County’s Internal Audit Department for audit based on the county’s risk-based, rotational audit planning process. The county determined the use of an outside, specialized internal audit provider would be optimal to successfully completing a value-added audit. After vetting various providers, the county selected Wipfli to perform this outsourced internal audit based on its strong cultural fit, price point, and in-house health care and technical expertise.

Strategy

Wipfli assembled a handpicked, cross-functional team consisting of experts in medical billing, medical information systems, and internal audit, and even an on-staff CPA who is also a registered nurse. Using a risk-based approach, the Wipfli team focused its efforts on DHHS areas where billable services represented a greater share of revenue. By conducting process walk-throughs and detailed transaction testing, the team worked to evaluate:

• Effectiveness of internal controls over billing.
• Accuracy of medical billing coding, adherence to processes, and timeliness of transactions.
• Use of the Practice Management System and soundness of the IT infrastructure.

Benefits

The final report exceeded the county’s internal audit manager’s expectations and provided DHHS opportunities to add best practices and operational process improvements. Wipfli confirmed that the general control structure in DHHS’s IT system was sound, but identified areas where the Practice Management System could be better utilized.

Wipfli also identified opportunities to improve processes, accuracy, and compliance and introduced DHHS to current best practices in billing and accounts receivable. By adopting Wipfli’s suggested improvements and efficiencies, DHHS expects to increase revenue and recovery for the county, thereby ensuring additional funds in support of its continued mission. 

Relationship Executive(s)

Robert D. Cedergren, CPA, CGMA, CITP, CISM, CISA, CGEIT, Partner In Charge, Risk Advisory Services