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Session ID: CON9346 Title: CMS Automates and Strengthens Internal Controls with Oracle Governance, Risk and Compliance ( PowerPoint Presentation
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Session ID: CON9346 Title: CMS Automates and Strengthens Internal Controls with Oracle Governance, Risk and Compliance ( - PowerPoint PPT Presentation


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Session ID: CON9346 Title: CMS Automates and Strengthens Internal Controls with Oracle Governance, Risk and Compliance (GRC) Wayne Bobby Vice President, Oracle Public Sector Industry Solutions Scott Beam, CPA, PMP Deputy Director, Division of Financial Application Systems John Stouffer

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slide1

Session ID: CON9346

Title: CMS Automates and Strengthens Internal Controls with Oracle Governance, Risk and Compliance (GRC)

Wayne Bobby

Vice President, Oracle Public Sector Industry Solutions

Scott Beam, CPA, PMP

Deputy Director, Division of Financial Application Systems

John Stouffer

Consultant

1

slide2

Agenda

Introductions

Centers for Medicare and Medicaid Services (CMS)

Healthcare Integrated General Ledger Accounting System (HIGLAS)

GRC Initiative at CMS

Project Approach

Implementation Summaries

Next Steps

Questions

slide3

THE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES is the United States government's principal agency for protecting the health of all Americans and providing essential human services, especially for those who are least able to help themselves

HHS REPRESENTS APPROXIMATELY ONE FIFTH OF ALL FEDERAL OUTLAYS

HHS Budget, FY 2012 -- $819.8 billion

The Centers for Medicare and Medicaid Services is one of 13operating divisions within the DHHS

Department of Health & Human Services (HHS)

slide4

Centers for Medicare & Medicaid Services (CMS)

CMS works with the health care community to:

  • improve the quality and efficiency in beneficiaries’ programs, services, and care, and
  • promote the fiscal soundness of an evolving health care system in the United States.

CMS administers the Medicare program and works in partnership with the States to administer Medicaid and the Children’s Health Insurance Program (CHIP).  Along with Health and Human Services (HHS), CMS also has begun to implement the provisions of the Affordable Care Act (ACA).

slide5

Centers for Medicare & Medicaid Services (CMS)

  • CMS is part of Department of Health & Human Services
  • CMS is one of the largest purchasers of health care in the world and represents 35 cents of every dollar spent on health care in the United States
  • CMS Budget FY 2012 -- $819.8 billion
  • Administers the Medicare Program and oversees the Medicaid Program
    • Medicare provides health insurance for more than 51 million beneficiaries
    • Provides funding to States for Medicaid for 56.6 million beneficiaries
slide6

Centers for Medicare & Medicaid Services (CMS)

  • CMS' Mission
    • To ensure effective, up-to-date health care coverage and to promote quality care for beneficiaries
  • CMS' Vision
    • To achieve a transformed and modernized health care system.
    • CMS will accomplish our mission by continuing to transform and modernize America's health care system.
  • CMS' Strategic Action Plan Objectives
    • Skilled, Committed, and Highly-Motivated Workforce
    • Accurate and Predictable Payments
    • High-Value Health Care
    • Confident, Informed Consumers
    • Collaborative Partnerships
slide7

HIGLAS= Healthcare Integrated General Ledger Accounting System

HIGLAS provides CMS an Oracle Federal Financials based solution to account for over $800+ Billion spent in outlays for healthcare each year

$1.77 Trillion Medicare Benefit Payments processed

4.9 Billion Claims processed totaling $1.94 Trillion

$291.7 B Medicaid and $9.0 B CHIP federal obligations to States

HIGLAS Solution

  • $57.9 B of AR/AP netted funds to recoup Medicare Benefit claims overpayments and preserve the Trust funds
  • $314.0 M of Federal tax and non-tax debts recouped under the Federal Payment Levy Program

Pre-HIGLAS

Post-HIGLAS

Customization of Financial Processes

Limited Customization

One Integrated Accounting System

Multiple Accounting System Processes

Standardized Financial Processes

Inconsistent Financial Processes

Manual Reports and Statements

Automated Reports and Statements

NOTE: Figures quoted above are cumulative through August 2013 which results in a 50TB Production environment.

slide8

HIGLAS Business Architecture

Oracle Enterprise

GRC Manager and

Intelligence

HIGLAS Oracle eBusiness Suite

Application

Foundation

Application

Modules

Staging

Oracle GRC

E-Business Suite

Transaction Controls

Trading

Community

Architecture

(TCA)

835

Remittance

Advice

271/274

Provider/

Bene.

837

Adjudicated

Claims

HIGLAS

Oracle GRC

E-Business Suite

Access Controls

Multi-Org

Accounts

Receivable

Application

Security

Accounts

Payable

OBIEE

Data Mart

Audit Trail

ETL

Oracle GRC

E-Business Suite

Configuration Controls

Concurrent

Processing

Loans

Cash

Management

Dashboards

General

Ledger

Online

Screens

& Reporting

Oracle

Preventive Controls

slide9

File System Storage/Landing Area

HTTP

FTP

HIGLAS Business Architecture

Oracle GRC

E-Business Suite

Access Controls

Oracle GRC

E-Business Suite

Configuration Controls

Oracle Enterprise

GRC Manager

Oracle GRC

E-Business Suite

Transaction Controls

HIGLAS

WebSphere

Oracle Federal Financials

External Systems

HIGLAS HISTORY

Accounts Payable

  • Receive MCS/FISS 271, 274, 810, 811R, 811S, 811VMP and 837 Files
  • Receive ReMAS 271 and 810 Files
  • Validate Files
  • Transformation
  • Load into Inbound Staging
  • Format & Generate 835 and 824S Files
  • Archive
  • Restore

MCS

FISS

ReMAS

  • Maintain Payees
  • Establish Payables
  • Generate Payments
  • Process Period-End

Accounts Receivable

  • Maintain Customers
  • Establish Receivables
  • Process Collections
  • Manage Receivables
  • Process Period-End

Manual

Oracle Forms

BI Data Analytics & Reporting

Oracle Preventive Controls Governor

General Ledger

  • Maintain GL
  • Generate GL
  • Post Journal Entries
  • Process Period-End
  • Data Mining
  • KPI Dashboards
  • Mgmt. Reporting
  • Predictive Modeling (Future)

Extensions

Production Audit

/ Error

  • Customer/Supplier X-Ref API
  • AR/AP Netting
  • Letters
  • 811 Payment Confirmation
  • 835 Extension
  • AP: 1099, Holds, Voids, Stale-dated Checks, CPT Interest
  • AR: AR Status, AR Interest
  • Payment Batch Set Automation

ASP

slide10

GRC Initiative at CMS

  • The GRC project was established to address key GRC initiatives in a number of phases to enable the organization to gain immediate value from the investment.
  • CMS partners with SRA International and Navillus Partners as implementation partners and trusted advisors to achieve these objectives-
    • Enhance automation of internal controls
    • Reduce enterprise-wide risk in HIGLAS
    • Support stronger compliance reporting
    • Reduce reliance on manual control processes
    • Eliminate HIGLAS software extensions and customizations, where feasible.
slide12

Application Access Controls Governor (ACG)

Introduces an automated Access analysis and reporting

Standardized access policies at a more granular level (i.e. function vs. responsibility)

Assist with role/responsibility definitions through simulation and analysis

Added GRC Intelligence to provide drilldown reporting and management level dashboards

slide13

Intelligence Dashboards Summarize access data

Enable CMS to personalize and create their own dashboards

Allows CMS to leverage business intelligence feature to accurately report an distribute information

GRC Intelligence (GRCi)

slide14

Increased Oracle audit trail effectiveness by removing unused tables and data

Moved much of the audit trail configuration to CCG for periodic snapshots and change tracking

Provides more accurate and timely documentation updates vs. manual documentation

Improves release schedule for changes by augmenting the audit trail

Eliminates some custom reporting previously used to identify changes and assist during audits

Configuration Controls Governor (CCG)

slide15

CMS leverages CCG for Change Tracking and Periodic Configuration Snapshots to support

Payables

Receivables

General Ledger

Purchasing

HRMS

Cash Management

Fixed Assets

Security and Administration

Federal Financials

Loans

Configuration Controls Governor (CCG)

slide16

Just ramping up…

Current customization and personalization are a target

Previous help desk tickets, data fixes are an obvious priority

Review areas with the application where users will benefit from automation

Advantages to PCG being an Oracle application…..thus it is not a customization.

Quick and easy to configure

Preventive Controls Governor (PCG)

slide17

Focus on

Payables

Receivables

General Ledger

System, Security and Administration

Reduce internal audit manual testing

Increase audit analysis accuracy

Eliminate sampling in lieu of 100% analysis

Log incidents and remediation systemically to provide a continuous monitoring and compliance system

Transaction Controls Governor (TCG)

slide18

Automate current CMS audit processes into one system

Provide audit reporting and Analysis

Reduce internal audit manual testing

Increase audit analysis accuracy

Eliminate sampling in lieu of 100% analysis

Log incidents and remediation systemically to provide a continuous monitoring and compliance system

Enterprise GRC Manager (eGRCM)

slide19

Q

&

Q u e s t i o n s

Q u e s t i o n s

A

A n s w e r s

A n s w e r s