Memoire EPS

Premire!certification!des!tablissements!publics!de!sant!:!nouvelle!mission!pour!le!commissaire!aux!comptes!

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#$%%&'() "Sommaire !. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . !1 !

Liste !des !abrviations !. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . !5 !

Table !des !figures !. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . !7 !

Note !de !synthse !. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . !8 !

Introduction ! . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . !11 !

Partie ! ! ! 1 ! ! ! ! LA ! PREMIRE ! CERTIFICATION ! DES ! TABLISSEMENTS !

PUBLICS ! DE ! SANT ! : ! PRISE ! DE ! CONNAISSANCE ! DE ! LENTIT ! ET ! DE !

SON !ENVIRONNEMENT !. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . !16 !

Chapitre!1!La!prsentation!dun!tablissement!public!de!sant!(EPS)!et!de!lvolution!de!

son!environnement!rglementaire!...................................................................................!18!

Section!1! Les!EPS!:!dfinition!et!rles!.......................................................................................!18!

1.1.! Prsentation!des!diffrentes!catgories!dEPS!..............................................................!18!

1.2! La!place!des!EPS!dans!le!paysage!hospitalier!en!France!................................................!20!

1.3! Personne!morale!de!droit!public!...................................................................................!21!

1.4! Le!centre!hospitalier!universitaire!(CHU)!:!lacteur!le!plus!reprsentatif!des!EPS!.........!21!

Section!!2! Lvolution!de!lenvironnement!rglementaire!des!EPS!:!du!plan!hpital!2007!au!

plan!hpital!2012!..............................................................................................................................!23!

2.1.! Pacte!de!modernit!pour!lhospitalisation!:!le!plan!hpital!2007!.................................!23!

2.2.! La!continuit!du!volet!investissement!du!plan!hpital!2007!:!le!plan!hpital!2012!......!24!

Section!3! La!rforme!des!hpitaux!:!la!loi!hpital,!patients,!sant!et!territoire!(HPST)!...........!26!

3.1.! Lorganisation!territoriale!du!systme!de!sant!............................................................!26!

3.2.! Lamlioration! de! laccs! ! des! soins! de! qualit! et! ! la! prvention! de! la! sant!

publique.27!

3.3.! La!modernisation!des!tablissements!de!sant.............................................................!28!

3.4.! Le!principe!de!la!certification!des!comptes!des!EPS!......................................................!29!

Chapitre!2!La!premire!certification!des!EPS!et!ses!enjeux!...............................................!30!

Section!1! Un!nouveau!march!pour!la!profession!...................................................................!30!


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1.1.! Les!champs!dintervention!respectifs!de!la!Cour!des!comptes!et!des!commissaires!aux!

comptes.!......................................................................................................................................!30!

1.2.! Les!EPS!concerns!par!la!certification!...........................................................................!31!

1.3.! Les!conditions!de!certification!des!tats!financiers!des!EPS!.........................................!32!

Section!2! Les!enjeux!pour!les!EPS!.............................................................................................!33!

2.1.! Un!puissant! levier!de!progrs!dans! la! rnovation!des!processus!et!des!organisations!

pour!les!EPS!..................................................................................................................................!33!

2.2.! La! certification! des! tats! financiers! facteur! damlioration! de! la! performance! des!

EPS..35!

Chapitre!3!Les!particularits!comptables!et!financires!des!EPS!.......................................!36!

Section!1! Une!sparation!des!fonctions!efficientes!.................................................................!36!

1.1.! Rles!et!responsabilits!de!lordonnateur!.....................................................................!36!

1.2.! Rles!et!responsabilits!du!comptable!..........................................................................!37!

Section!2! Les!particularits!induites!par!le!contexte!rglementaire!........................................!38!

2.1.! Le!rfrentiel!comptable!de!rigueur!:!linstruction!M21!...............................................!38!

2.2.! Prsentation!des!tats!financiers!..................................................................................!39!

2.3.! Les!contraintes!induites!par!le!secret!mdical!..............................................................!40!

Section!3! Zoom!sur!la!spcificit!du!systme!de!facturation!...................................................!41!

3.1.! Volume!de!facturation!!traiter!lev!...........................................................................!41!

3.2.! Complexit!des!rgles!de!facturation!............................................................................!42!

Chapitre!4!Aspects!comptables,!financiers!et!budgtaires!:!tat!des!lieux!et!plan!daction

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Section!1! Le!bilan!de!la!situation!comptable,!financire!et!budgtaire!actuelle!tabli!par!la!

Cour!des!comptes!et!par!les!chambres!rgionales!et!territoriales!des!comptes!..............................!43!

1.1.! Les!tudes!de!la!Cour!des!comptes!:!fiabilit!des!comptes!et!situation!financire!.......!43!

1.2.! Les!tudes!des!chambres!rgionales!et!territoriales!des!comptes!................................!46!

Section!2! La!prparation!!la!certification!des!tats!financiers!................................................!47!

2.1.! La!phase!prparatoire!:!mise!en!place!de!trois!groupes!de!travail!................................!47!

2.2.! La!prparation!des!EPS!!la!certification!.......................................................................!50!

2.3.! Quelques!exemples!de!mise!en!uvre!.........................................................................!52!

Partie ! 2 ! LA ! DMARCHE ! DU ! COMMISSAIRE ! AUX ! COMPTES ! : !

PROPOSITION !DOUTILS !DAIDE ! !LA !PREMIRE !CERTIFICATION !DES !

TATS ! FINANCIERS ! DES ! EPS ! ET ! COMPARATIF ! AVEC ! DAUTRES !


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TABLISSEMENTS ! PUBLICS ! SOUMIS ! RCEMMENT ! ! LA !

CERTIFICATION !. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . !55 !

Chapitre!1!La!dmarche!du!commissaire!aux!comptes!lors!de!la!premire!certification!des!

tats!financiers!des!EPS!...................................................................................................!57!

Section!1! La!prparation!de!la!mission!:!dfinition!dune!cartographie!et!classification!des!

risques..!.................................................................................................................................!57!

1.1.! Lapproche!par!les!risques!de!lauditeur!.......................................................................!57!

1.2.! La!notion!de!contrle!interne!........................................................................................!59!

1.3.! Ralisation!de!la!cartographie!des!risques!au!sein!dun!EPS!.........................................!61!

1.4.! La!rponse!aux!risques!identifis!:!diligences!du!commissaire!aux!comptes!................!63!

Section!2! La!validation!du!bilan!douverture!:!un!objectif!!2013!............................................!64!

2.1.! La!norme!dexercice!professionnel!510!.........................................................................!64!

2.2.! Les!enjeux!de!la!validation!du!bilan!douverture!...........................................................!64!

2.3.! Proposition!dun!programme!de!travail!en!vue!de!la!validation!du!bilan!douverture!.!67!

Section!3! La!dfinition!dun!programme!de!travail!en!vue!de!la!premire!certification!des!

tats!financiers!des!EPS!....................................................................................................................!69!

3.1.! Rappel!des!!classiques!!en!audit!................................................................................!69!

3.2.! Les!points!spcifiques!au!secteur!tudi!.......................................................................!71!

3.3.! Proposition!dun!programme!de!travail!intgrant!les!spcificits!du!secteur!tudi!...!73!

Chapitre!2!Zoom!sur!les!cycles!spcifiques!du!secteur!tudi!...........................................!74!

Section!1! Les!moyens!humains!.................................................................................................!74!

1.1.! Le!cycle!personnel!riche!de!statuts!et!de!rgles!particulires!.......................................!74!

1.2.! valuation!des!dettes!diffres!.....................................................................................!76!

1.2.! Assertions!et!diligences!proposes!en!rponse!aux!risques!identifis!..........................!78!

Section!2! Les!moyens!actifs!......................................................................................................!79!

2.1.! Les!immobilisations!:!identification!et!dprciation!.....................................................!79!

2.2.! Les!stocks!.......................................................................................................................!83!

2.3.! Le!suivi!des!en"cours!clients!..........................................................................................!86!

Section!3! La!gestion!des!provisions!..........................................................................................!89!

3.1.! Les!provisions!:!un!outil!dajustement!pour!une!comptabilit!avant!tout!budgtaire!..!89!

3.2.! La!sparation!des!exercices!:!rattachement!au!bon!exercice!et!correcte!estimation!...!91!

3.3.! Les!provisions!pour!risques!et!charges!..........................................................................!92!

Chapitre!3!Du!dossier!de!travail!du!commissaire!aux!comptes!!lmission!de!son!opinion

!........................................................................................................................................!94!


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Section!1! Le!suivi!des!diligences!du!commissaire!aux!comptes!via!la!documentation!de!son!

dossier!de!travail!..............................................................................................................................!94!



1.3.! La!traabilit!des!travaux!de!lauditeur!lgal!.................................................................!97!

Section!2! La!finalisation!de!la!mission!de!lauditeur!lgal!........................................................!98!

2.1.! Exemple!de!plan!de!synthse!du!commissaire!aux!comptes!........................................!98!

2.2.! Les!vrifications!spcifiques!du!commissaire!aux!comptes!...........................................!99!

2.3.! Lmission! de! lopinion! du! commissaire! aux! comptes!:! rapport! sur! les! comptes!

annuels99!

Section!3! Les!retours!dexprience!dautres!tablissements!publics!soumis!rcemment!!la!

certification..!................................................................................................................................!101!

3.1.! Les!tablissements!publics!!caractre!scientifique,!culturel!et!professionnel!...........!101!

3.2.! Les!organismes!de!protection!sociale!..........................................................................!102!

Conclusion !. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . !105 !

Bibliographie !. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . !109 !

Annexes !. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . !121 !

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Premire!partie!:!La!premire!certification!des!tablissements!publics!de!sant!:!prise!de!connaissance!de!lentit!et!de!son!environnement!

"

!W"

"

"

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Partie ! ! !1!!!!LA!PREMIRE!CERTIFICATION!DES!

TABLISSEMENTS!PUBLICS!DE!SANT!:!

PRISE!DE!CONNAISSANCE!DE!LENTIT!ET!

DE!SON!ENVIRONNEMENT!

"

Premire!partie!:!La!premire!certification!des!tablissements!publics!de!sant!:!prise!de!connaissance!de!lentit!et!de!son!environnement!

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!a"

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Partie!1,!chapitre!1!:!La!prsentation!dun!EPS!et!de!lvolution!de!son!environnement!rglementaire!

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!e"

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"

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!Chapitre!1!La!prsentation!dun!tablissement!public!de!

sant!(EPS)!et!de!lvolution!de!son!

environnement!rglementaire!

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Section!1! Les!EPS!:!dfinition!et!rles!

1.1.! Prsentation!des!diffrentes!catgories!dEPS!

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Section!!2! Lvolution!de! lenvironnement! rglementaire!des!EPS!:!du!plan!

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:&'//)"5&0'$5&?)"1)"/$?'1&('03U"1)/"()//$9(:)/"A($A()/U"1$5/")0"?)>/")0"/9("95)"

2&/)" 4$?$50&'()U" 1)/" 4)(/)%)50/" 1)" :$??):0'4'03/" 0)(('0$('&?)/" $9" 1@&90()/"

30&2?'//)%)50/" A92?':/h" .)" A)(/$55)?" 1)" ?@&>)5:)" :$%A()51" 1)/"

C$5:0'$55&'()/U" 1)/"%31):'5/U" 1)/" A;&(%&:')5/U" 1)/" &>)50/" :$50(&:09)?/" 1)"

1($'0"A92?':")0"A('43h"

"

3.2.! Lamlioration!de!laccs!!des!soins!de!qualit!et!!la!prvention!de!la!

sant!publique!

.@&(0':?)"+W"1)"?&"?$'"E=#I"13C'5'0"?@&::X/"&9G"/$'5/"1)"A()%')("():$9(/")0"?&"A('/)")5"

:;&(>)":$50'59)"1)/"%&?&1)/"Y&(0':?)".h"!,!!c!!"F#=Zh"

.@&%3?'$(&0'$5"1)"?@&::X/"B"1)/"/$'5/"1)"Q9&?'03U"A$(03)"A&("?&"SEM#")0"A&("?&"S##U"&"

A$9(" $2O)0" 1@$A0'%'/)(" ?@&::X/" 1)" 0$9/" B" 1)/" /$'5/" 1)" Q9&?'03U" /9(" ?@)5/)%2?)" 19"

0)(('0$'()U"0$90")5"()/A):0&50"?&"?'2)(03"1@'5/0&??&0'$5"1)/"A($C)//'$55)?/"?'23(&9Gh""

.@$(>&5'/&0'$5" 1)" ?@$CC()" 1)" /$'5/" )0" 1)/" 2)/$'5/" 1)" /&503" /@30&2?'0" /9(" A?9/')9(/"

5'4)&9G"i"

c 1)/"/:;3%&/"(3>'$5&9G"1@$(>&5'/&0'$5"1)/"/$'5/U"

c 1)/"A()%')(")0"/):$51"():$9(/U"

c 1)"?&"A)(%&5)5:)"1)/"/$'5/"&%29?&0$'()/U"

c 1)"?&"(3A&(0'0'$5"(3>'$5&?)"1)/"%31):'5/U"

c 1)"?&":$$A3(&0'$5")50()"?)/"A($C)//'$55)?/U"

c 1)" ?&" C$(%&0'$5" %31':&?)" :$50'59)" 1)4)5&50" 134)?$AA)%)50" A($C)//'$55)?"

:$50'59U"

c 1)/"$(1()/"A($C)//'$55)?/h"


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*e"

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.&"A(34)50'$5"1)"?&"/&503"A92?'Q9)"4'/)"?)/"%&?&1')/":;($5'Q9)/")0"?)/":&5:)(/"i"?&"

A(34)50'$5"1)"?)9(/"A('5:'A&9G"C&:0)9(/"1)"('/Q9)"Y&?:$$?U"0&2&:ZU"&'5/'"Q9)":)??)"1)"

?)9(/":$%A?':&0'$5/")0"1)"?)9(/"():;90)/U"A&("?@319:&0'$5"0;3(&A)90'Q9)"19"A&0')50h"

=$9("?&"A()%'X()"C$'/U":)??)c:'")/0"3('>3)")5"A$?'0'Q9)"5&0'$5&?)h"

=?9/')9(/"&90()/"%)/9()/"A('$('0&'()/"$50"303"A('/)/")5"C&4)9("1)"i"

c ?&"A($0):0'$5"1)"?&"/&503")54'($55)%)50&?)U""

c 1)/"C)%%)/")0"1)":)(0&'5)/"A$A9?&0'$5/"49?53(&2?)/U""

c ?&"?900)":$50()"?@$23/'03U""

c ?@319:&0'$5"0;3(&A)90'Q9)"19"A&0')50U""

c ?@'50)(1':0'$5"$9"?@)5:&1()%)50"1)"?&"4)50)"1@&?:$$?")0"1)"0&2&:U"A$9("A($03>)("

?)/"A?9/"O)95)/h"

"

3.3.! La!modernisation!des!tablissements!de!sant!

.&" %$1)(5'/&0'$5" 1)/" 30&2?'//)%)50/" 1)" /&503" &" A$9(" $2O)0" 1)" ()5C$(:)(" ?)/"

%'//'$5/" 1)" /)(4':)" A92?':" 1)/" 30&2?'//)%)50/U" 1@&??3>)(" ?)9(/" :$50(&'50)/" 1)"

C$5:0'$55)%)50")0"1)"13:?$'/$55)("?)9("$(>&5'/&0'$5U"0$90")5"C&4$('/&50"?&"%'/)")5"

A?&:)"1)":$$A3(&0'$5/"B"?@3:;)??)"1)/"0)(('0$'()/h".)/"30&2?'//)%)50/"/$50"3>&?)%)50"

'54'03/"B"&AA$(0)("A?9/"1)"0(&5/A&()5:)"Q9&50"B"?&"Q9&?'03")0"B"?&"/3:9('03"1)"?&"A('/)"

)5":;&(>)"19"A&0')50h"

.&" %$1)(5'/&0'$5" 1)/" 30&2?'//)%)50/" 1)" /&503" /@)CC):09)" /)?$5" A?9/')9(/"

&G)/"1@&%3?'$(&0'$5"i"

! S9"C$5:0'$55)%)50"1)/"30&2?'//)%)50/"&4):"5$0&%%)50"i"

c 95)"()13C'5'0'$5"1)/"%'//'$5/"1)"/)(4':)"A92?':U""

c ?&":?&('C':&0'$5"19"/0&090"1)/"30&2?'//)%)50/"1)"/&503U""

c ?&" :?&('C':&0'$5" 1)" ?&" >$94)(5&5:)" 1)/" 30&2?'//)%)50/" A92?':/" 1)" /&503"

/9("A?9/')9(/"5'4)&9G"Y:$5C)("&55)G)"!ZU"

c ?&"?'2)(03"1@$(>&5'/&0'$5"'50)(5)"1)/"H=#U""

c ?@&//$9A?'//)%)50"1)"?&">)/0'$5"1)/"H=#U""


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*f"

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c 95)")G'>)5:)"&::(9)"/9("?)/":;&%A/"1)"?&"Q9&?'03")0"1)"?&"/3:9('03h"

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;$/A'0&?'X()/"1)"0)(('0$'()")0"?)/">($9A)%)50/"1)":$$A3(&0'$5"/&5'0&'()h"

! S)"?&"A)(C$(%&5:)"1)/"30&2?'//)%)50/"&4):"?&":(3&0'$5"1)"?@6

Partie!1,!chapitre!2!:!La!premire!certification!des!EPS!et!ses!enjeux!

+g"

"

"

""!

"

"

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!Chapitre!2!La!premire!certification!des!EPS!et!ses!

enjeux!

"

"

&" ?$'"E=#I" '50($19'0" 95"%$1)" 1)" :$50(L?)" )G0)(5)" &4):" ?&" :)(0'C':&0'$5"

1)/" 30&0/" C'5&5:')(/" 1)/" H=#h" .)/" )5O)9G" /$50" /'>5'C':&0'C/" )0" ?)/"

:$51'0'$5/"1@&AA?':&0'$5" 0(X/" /A3:'C'Q9)/h" K?" /@&>'0"1@95"5$94)&9" :;&??)5>)"A$9(" ?)"

A($C)//'$55)?"Q9'"&"95)"(3)??)"4&?)9("&O$903)"B"&AA$(0)(h"

"

Section!1! Un!nouveau!march!pour!la!profession!

1.1.! Les! champs! dintervention! respectifs! de! la! Cour! des! comptes! et! des!

commissaires!aux!comptes!

.&"?$'"E=#I"19"*!"O9'??)0"*ggfU"%$1'C'3)"A&("?)"A($O)0"1)"?$'")5":$9(/"1@)G&%)5"&9"

=&(?)%)50U"13C'5'0"?)":&1()"?3>'/?&0'C"1)/":$%A0)/"1)/"H=#h"

.@&(0':?)"!a"1)":)00)"?$'"&"'5/:('0"1&5/"?)"F$1)"1)"?&"/&503"A92?'Q9)U"&(0':?)".h"W!,-c

!WU" ?)"A('5:'A)"1)":)(0'C':&0'$5"1)/":$%A0)/"1)":)(0&'5/"30&2?'//)%)50/"A92?':/"1)"

/&503h"

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.


!

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+!"

"

J5"13:()0")5"F$5/)'?"1@V0&0"4')51(&"&1&A0)("?)"F$1)"1)/"O9('1':0'$5/"C'5&5:'X()/")5"

C'G&50"?)/"%$1&?'03/"1)":)(0'C':&0'$5"A&("?&"F$9("1)/":$%A0)/"Y&(0':?)".h"!+*c+c+Zh"

6" A('$('U" ?&" :$%A30)5:)" 1)" ?&" F$9(" 1)/" :$%A0)/" A$(0)(&'0" /9(" ?)/" e" FEJ" ?)/" A?9/"

'%A$(0&50/U" B" /&4$'("&P&50" 1)/" ():)00)/" /9A3(')9()/" B" agg" %'??'$5/" 1@)9($/h" K?"

/@&>'(&'0"1)/"FEJ"1)"=&('/U"7&(/)'??)U".P$5U".'??)U"k$(1)&9GU"I$9?$9/)U"7$50A)??')("

)0"#0(&/2$9(>h".&":$%A30)5:)"1)/"F6F"A$(0)(&'0"/9("?)/"!+g"B"!,g"30&2?'//)%)50/"

&P&50"1)/"():)00)/"/9A3(')9()/"B"!gg"%'??'$5/"1@)9($/h"

""

J5" 13:()0" /'%A?)" 4')51(&" 13C'5'(" ?)/" 30&2?'//)%)50/" /$9%'/" B" ?&" :)(0'C':&0'$5" 1)/"

:$%A0)/U":$5C$(%3%)50"&9G"1'/A$/'0'$5/"A(349)/"A&("?@&(0':?)".h"W!,-c!W"19"F$1)"

?&"/&503"A92?'Q9)h"

"

1.2.! Les!EPS!concerns!par!la!certification!

F)(0)/U" ?&" :)(0'C':&0'$5" 1)/" :$%A0)/" 1)/" H=#" )/0" 95" &G)" %&O)9(" 1)" 0(&4&'?"j"

:)A)51&50U"/)9?/":)(0&'5/"1@)50()")9G"P"/)($50"/$9%'/h"S)":)"A($O)0"1)":)(0'C':&0'$5"

)/0"53)"95)"A('$('03"1)"C'&2'?'/&0'$5"1)/":$%A0)/U"Q9'U")??)U":$5:)(5)"0$9/"?)/"H=#h"

"

.&"C'>9()":'c1)//$9/"()C?X0)"?)/"$2O):0'C/"1)":;&Q9)":&03>$(')"1@30&2?'//)%)50"i"

"

"

!

Source!:!DGOS,!avancement!du!projet!fiabilisation!et!certification!des!comptes!des!tablissements!publics!de!

sant!

Figure!3!:!Objectifs!de!chaque!catgorie!dtablissement!

Tous!les!EPS!:!fiabilisation!des!comptes

X EPS!dfinis!par!dcret!certifis!par!un!CAC

8!CHU!certifis!par!la!Cour!des!comptes

Certification!des!comptes!de!2015!

au!!plus tard

Echance !dfinir


!

"

+*"

"

1.3.! Les!conditions!de!certification!des!tats!financiers!des!EPS!

F$50(L?)("?&"C'&2'?'03"1)/":$%A0)/"&4&50"1@)5>&>)("95)"&5&?P/)"C'5&5:'X()":$5/0'09)"

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?@)51)00)%)50"A92?':/"B"A&(0'("1)":$%A0)/"Q9'"/)(&')50"'5/'5:X()/h"

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?)9(">)/0'$5U"1)"?)9("A&0('%$'5)")0"1)"?)9(">)/0'$5"C'5&5:'X()h"q"

.)"A('5:'A)"1)" /'5:3('03" )/0" B" ()?')(" B" ?&" 5$0'$5"1)" C'&2'?'03"1)/" :$%A0)/h" #)?$5" ?)"

:&1()":$5:)A09)?"1)"?&":$%A0&2'?'03"1)"?@V0&0U" ?&"C'&2'?'03"1)/":$%A0)/"A&(0':'A)"&9"

A('5:'A)"1)"2$55)" '5C$(%&0'$5h"I$9O$9(/" /)?$5" ?&"%^%)" /$9(:)U" 95)" '5C$(%&0'$5"

C'&2?)" 1$55)" 95)" '%&>)" C'1X?)" 1)" :)" Q9@)??)" )/0" :)5/3)" A(3/)50)(" )0" 1)" :)" Q9@$5"

A$9((&'0"/@&00)51()"(&'/$55&2?)%)50"B"?&"4$'("A(3/)50)(h""

.@$2O):0'C"1)"?&":)(0'C':&0'$5")/0"1)"/@&//9()("Q9)"?)/":$%A0)/"()A(3/)50)50"?@'%&>)"

C'1X?)"1)"?&"/'09&0'$5"C'5&5:'X()")0"A&0('%$5'&?)"1)/"30&2?'//)%)50/h"

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.)/"30&0/"C'5&5:')(/"1)/"H=#"A$9(($50"^0()":)(0'C'3/"1&5/"?)/":$51'0'$5/"/9'4&50)/"i"

! w9)?/" /$50" ?)/" 30&0/" C'5&5:')(/" B" :)(0'C')("d" Le! bilan,! le! compte! de! rsultat,!

lannexe.!

! w9)?" /)(&" ?)" (3C3()50')?" :$%A0&2?)" $AA$/&2?)"d" Sagissant!de! la!certification!

des! comptes!hospitaliers,!au! sens!de! la!norme! internationale! ISA,! il! existe!un!

rfrentiel!comptable!opposable,!linstruction!budgtaire!et!comptable!M21.!

"

S9"A$'50"1)"49)"A(&0'Q9)"A$9("?)/"H=#U"?&":)(0'C':&0'$5"1)/"?)9(/"30&0/"C'5&5:')(/"5)"

/)(&" A$//'2?)" Q9)" ?$(/Q9)" ?)/" 0(&4&9G" /)($50"%)53/" )5"%$1)"A($O)0" )0" $(>&5'/3/"

/)?$5"?)/"&G)/"13:('0/":'c&A(X/h"


!

"

++"

"

"

Source!:!DGOS,!avancement!du!projet!fiabilisation!et!certification!des!comptes!des!tablissements!publics!de!

sant!

Figure!4!:!Axes!des!travaux!!mener!en!mode!projet!

!

Section!2! Les!enjeux!pour!les!EPS!

2.1. Un!puissant!levier!de!progrs!dans!la!rnovation!des!processus!et!des!

organisations!pour!les!EPS!

64&50" 1@3091')(" ?)/" )5O)9G" A$9(" ?)/" H=#U" '?" :$54')50" 1@)CC):09)(" 95" (&AA)?" 1)/"

C$51&%)50&9G"1)"?@&91'0"i"

! .&"13%&(:;)"19":)(0'C':&0)9(")/0"C$513)"/9("?@&AA($:;)"A&("?)/"('/Q9)/h"

! #$5" $2O):0'C" )/0" 1@&AA(3:')(" :$%%)50" ?@$(>&5'/&0'$5U" ?)/" A($:)//9/" )0" ?)/"

1'/A$/'0'C/" 1)" :$50(L?)/" %'/" )5" A?&:)" &//9()50" 95" 5'4)&9" 1)" %&m0('/)"

/&0'/C&'/&50"1)":)/"('/Q9)/h"

! .)/" 5$(%)/" 1@&91'0" '50)(5&0'$5&?)/" )0" C(&5n&'/)/" '5/'/0)50" /9(" ?@'%A$(0&5:)"

A$9("?@&91'0)9(")G0)(5)"i"

c 1)"2')5":$%A()51()"?@)54'($55)%)50"1&5/"?)Q9)?"$AX()"?)":?')50U"

Etats!fianciers!certifis

Dvelopper!le!contrle!interne!comptable!(CIC)

Sensibilisation!/!formation!au!CIC Audit!/!diagnostic

Elaboration!du!plan!d'actions!pluriannuel

Mise!en!oeuvre!et!suivi!du!plan!d'actions

Adapter!les!systmes!informatiques Ingtgration!CIC Piste!d'audit Hierarchie!/!habilitations

Piloter!le!projet Communication Gestion!des!risques Arbitrages Affectation!des!moyens

Amliorer!la!qualit!comptable

Formation!/!volutions!comptables Audit!/!diagnostic

Rvisions!des!critures!comptables

Prparation!du!bilan!d'ouverture

Faciliter!l'audit!NBon!droulement!du!1er!

auditMise!!jour!du!dossier!

permanent

Prise!en!comptes!des!ventuelles!rserves!de!certification!ds!N+1

Leve!des!ventuelles!rserves!de!certification!

au!plus!tard!en!N+3


!

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+,"

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c 1@&AA(3:')("?)/"('/Q9)/"'5;3()50/"B"/)/"&:0'4'03/U"

c 1@34&?9)("?)/"1'/A$/'0'C/"1)":$50(L?)"'50)(5)"%'/")5"l94()h"

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'50)(5)" :$%%)" 95" A($:)//9/" %'/" )5" l94()" A&(" ?)/" 1'('>)&50/" B" 0$9/" ?)/"

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c ?@)CC':&:'03")0"?@)CC':')5:)"1)/"$A3(&0'$5/U"

c ?&"C'&2'?'03"1)/"'5C$(%&0'$5/"C'5&5:'X()/U"

c ?&":$5C$(%'03"&9G"?$'/")0"(X>?)%)50/h"

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1@&91'0&2'?'03" )0" 1)" /3:9('03" ?$>'Q9)" /)" 0(&19'/)50" A&(" 95" A?9/" C$(0" ():$9(/" B" 1)/"

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)G0)(5)" 1)" ?&" Q9&?'03" 1)" ?@$(>&5'/&0'$5" 1)" ?@30&2?'//)%)50" )/0" 90'?)" B" ?@3Q9'A)"

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'5C$(%&0'$5/"0(&5/%'/)/"&9G"&90$('03/oZh"

""""""""""""""""""""""""""""""""""""""""""""""""""""""""!!"Committee! Of! Sponsoring! Organizations! (COSO)! of! the! Treadway! Commission"i" '?" /@&>'0" 1@95)":$%%'//'$5"B"290"5$5"?9:(&0'C"Q9'"&"30&2?'")5"!ff*"95)"13C'5'0'$5"/0&51&(1"19":$50(L?)"'50)(5)")0"&":(33"95":&1()"A$9("34&?9)("/$5")CC':&:'03h"""


!

"

+-"

"

2.2.! La! certification! des! tats! financiers! facteur! damlioration! de! la!

performance!des!EPS!

S&5/"/&"13%&(:;)U"?)":)(0'C':&0)9("p"'50)(A)??)"q"?)/"$(>&5'/&0'$5/U"?)/"A($:)//9/U")0"

?)/" /P/0X%)/" 1@'5C$(%&0'$5" Y)0" A&/" 95'Q9)%)50" :$%A0&2?)/ZU" ?)/" A(&0'Q9)/" 1)"

A'?$0&>)")0"1)":$50(L?)"'50)(5)h"

.)" :$50(L?)" '50)(5)" )/0" &4&50" 0$90" 95" 1)/" &00('290/" 1)" ?&" 2$55)" >)/0'$5" 1)/"

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%&m0('/)"1)"?)9(/"&:0'4'03/h"

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A$9("95)"$(>&5'/&0'$5"1)"i"

c (3C?3:;'("/9("/)/"$2O):0'C/")0"/)/"%'//'$5/"j"

c 34&?9)("?)/"('/Q9)/"A)/&50"/9("?@&00)'50)"1)"/)/"$2O):0'C/"j"

c :$%A&()(U" (&0'$5&?'/)(U" /'%A?'C')(" )0" $A0'%'/)(" :)(0&'5)/" A($:319()/"

;'/0$('Q9)/U")5"90'?'/&50"5$0&%%)50"?&"A9'//&5:)"1)/"/P/0X%)/"1@'5C$(%&0'$5h"

"

K?" :$54')50" 1)" 5$0)(" Q9)" ?@)GA3(')5:)" %$50()" Q9)" ?)/" )50'03/" Q9'" :?L09()50"

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"

Figure!5!:!En!quoi!la!certification!contribue"t"elle!!lamlioration!de!la!performance!?!

!!!!!!!!!!!!!!!!!!!!!!!!!Un!vritable!projet!d'entreprise

.!la!dmarche!n'est!pas!un!processus!!part!dans!l'entit

.!la!qualit!de!l'information!financire!et!comptable!ne!dpend!pas!

que!de!la!seule!matrise!des!processus!comptables!mais!aussi!des!

processus!en!amont

.!l'implication!des!mtiers!dans!la!dfinition!et!le!mise!en!oeuvre!de!

la!stratgie!de!contrle

!!!!!!!!!!!!!!!Elle!est!un!outil!essentiel!de!dialogue!et!de!pilotage

.!transparence!financire

.!non!opposabilit!des!donnes

.!un!outil!de!contractualisation

.!un!outil!de!pilotage!trs!performant!qui!permet!de!rorienter!

l'action,!de!connatre!les!marges!de!manoeuvre!et!d'objecter!la!

performance

!!!!!!!!!!!!!!!La!certification!fait!"bouger!les!lignes"

.!elle!induit!un!alignement!progressif!de!l'organisation!!la!startgie!

de!certification

.!il!s'agit!d'un!projet!qui!ne!peut!pas!se!faire!!organisation!constante

.!ce!projet!mobilise!tous!les!acteurs

.!elle!demande!de!repenser!les!processus,!les!pratiques!de!travail

.!elle!rime!avec!matrise!des!activits

.!se!concentre!sur!les!risques!majeurs

Certification/

Performance

Partie!1,!chapitre!3!:!Les!particularits!comptables!et!financires!des!EPS!

+W"

"

"

!!!!!!!!!!Chapitre!3!Les!particularits!comptables!et!financires!

des!EPS!

"

)" :;&A'0()" %)0" )5" )G)(>9)" ?)/" 3?3%)50/" :?3/" Q9'" 1'/0'5>9)50"

?@$(>&5'/&0'$5"1@95"H=#"1)":)??)/"1)/"/$:'303/":$%%)(:'&?)/h"F&(U"%^%)"

/'" ?&"%'//'$5" 1)" ?@&91'0)9(" 0)51" B" /)" 134)?$AA)(" 1&5/" ?@)54'($55)%)50" A92?':U" ?)"

/):0)9(" ;$/A'0&?')(" ()/0)" 5$94)&9" A$9(" ?9'" )0" ?)/" A&(0':9?&('03/" B" %&m0('/)(" /$50"

5$%2()9/)/h"

"

Section!1! Une!sparation!des!fonctions!efficientes!

1.1. Rles!et!responsabilits!de!lordonnateur!

.@&(0':?)" -" 19" 13:()0" 19" *f" 13:)%2()" !fW*" 13C'5'0" ?)" (L?)" 1)/" $(1$55&0)9(/" )0"

&CC'(%)"i"p".)/"$(1$55&0)9(/"A()/:('4)50"?@)G3:90'$5"1)/"():)00)/")0"1)/"13A)5/)/h"q"

H5"%&0'X()"1)"13A)5/)/U"0($'/"A;&/)/"/)"/9::X1)50"i""

c ?@)5>&>)%)50"i"/&9C")G:)A0'$5U"?@$(1$55&0)9("5)"A)90")5>&>)("A?9/"1)":(31'0/"

Q9@'?"5@)/0"A(349"&9":;&A'0()"291>30&'()"j!

c ?&"?'Q9'1&0'$5U"Q9'":$5/'/0)")5"95)"43('C':&0'$5"1)"?&"(3&?'03"1)"?&"1)00)")0"1)"?&"

(3&?'03"1)/"0'0()/"1)"A&')%)50"Y1)4'/U"C&:09()/Z"j!

F


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+a"

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c ?@$(1$55&5:)%)50"i"'?"/@&>'0"1)"?@&:0)"/'>53"A&("?@$(1$55&0)9(")0"1$55&50"$(1()"

1)"A&P)("&9":$%A0&2?)h!

.)/" $A3(&0'$5/" 1)" ():)00)/" C$50" /9'0)" B" 95" $(1()" 1@)5:&'//)%)50" 0(&5/%'/" A&("

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^0()"&::$%A&>53/"1)"A'X:)/"O9/0'C':&0'4)/h"

" "

1.2.! Rles!et!responsabilits!du!comptable!

=&(0':9?&('03"C$(0)"1)/";LA'0&9GU"?)":$%A0&2?)"5)"C&'0"A&/"A&(0')"1)"?@30&2?'//)%)50U"

'?" 5@)/0" A&/U" 1&5/" ?&" A?9A&(0" 1)/" :&/U" 131'3" B" ?@30&2?'//)%)50" )0" ()?X4)" 1@95)"

;'3(&(:;')"1'CC3()50)U" '?")/0"&>)50"19"I(3/$("A92?':h" K?"&//9()" ?)" ():$94()%)50"1)/"

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>($/"FE"1'/A$/)"1@95)"0(3/$()(')"131'3)h"

"

#'"95"$(1$55&0)9("%&5')"1)/"C$51/"B"?&"A?&:)"19":$%A0&2?)U" '?")G)(:)"95)">)/0'$5"

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c ?&"Q9&?'03"1)"?b$(1$55&0)9(")0"19"1)/0'5&0&'()"1)"?b$A3(&0'$5"j""

c ?b)G&:0)" '%A90&0'$5" )0" )5" 13A)5/)/" /'" ?)" %$50&50" 1)/" :(31'0/" 5b)/0" A&/"

13A&//3"j""

c /'"?&"0(3/$()(')"A)(%)0"1)"A&P)("j"

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%3%$'()/U":$50(&0/U"13?'23(&0'$5/U"%&(:;3/Zh""

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(X>?)%)50">353(&?"/9("?&":$%A0&2'?'03"A92?'Q9)U"&(0':?)/"!fU"!*")0"!+h"


"

+e"

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A('5:'A)"C$51&%)50&?"19"1($'0"291>30&'()")0"C'5&5:')("A92?':"C(&5n&'/h"

F)00)"/3A&(&0'$5"1)/"C$5:0'$5/")/0"A$0)50')??)%)50"A$(0)9/)"1@95)"1'/:$50'59'03"1)"

?&" A'/0)" 1@&91'0" 1)/" 3:('09()/" :$%A0&2?)/" )50()" ?&" /A;X()" 1)" ?@$(1$55&0)9(" )0" 19"

:$%A0&2?)h" &5'/%)"A92?':" Q9'" 2353C':')"

1@95)" 43('C':&0'$5" 1)/" 13A)5/)/" &4&50" Q9@)??)/" /$')50" (3&?'/3)/h" H??)" &AA$(0)"

3>&?)%)50" 95)" >&(&50')" &9" :$50('29&2?)" $9" B" ?@9/&>)(" 19" /)(4':)" A92?':" Q9'"

2353C':')"1@95)"43('C':&0'$5"1)"?@)G&:0'091)"1)"?&"():)00)"B"A)(:)4$'(h"

"

Section!2! Les!particularits!induites!par!le!contexte!rglementaire!

2.1.! Le!rfrentiel!comptable!de!rigueur!:!linstruction!M21!

.@'5/0(9:0'$5":$%A0&2?)")0"291>30&'()"7*!":$5/0'09)" ?)"(3C3()50')?":$%A0&2?)"1)/"

30&2?'//)%)50/"A92?':/"1)"/&503h"H5" ?@&2/)5:)"1)"(X>?)":$%A0&2?)"1&5/" ?&"7*!U" ?)"

=FT"Y(X>?)%)50"FDF"5r"ffcg+Z"/@&AA?'Q9)h"F)/"(X>?)/"/@'%A$/)50"&9G"$(1$55&0)9(/U"

&9G":$%A0&2?)/")0"&9G"$(>&5'/%)/":;&(>3/"1@)G&%'5)("?)/":$%A0)/h"

"

.@'5/0(9:0'$5" 7*!" )/0" &//)N" A($:;)" 19" " =FTh" .)/" 1'CC3()5:)/" A($4')55)50"

)//)50')??)%)50" 1)/" /A3:'C':'03/" O9('1'Q9)/" )0" 3:$5$%'Q9)/" 1)/" 30&2?'//)%)50/h"


"

+f"

"

.@'5/0(9:0'$5"7*!"C)(&"?@$2O)0"1@34$?90'$5/")5"5$%2()"?'%'03U"1$50"?&"%'/)")5"l94()"

'50)(4')51(&"&9"!)("O&54')("*g!*")0"&9"!)("O&54')("*g!+h"

.)/"34$?90'$5/")0":?&('C':&0'$5/"&00)519)/"A$(0)($50"/9("i"

c ?)" 0(&'0)%)50" 1)/" :$(():0'$5/" 1@)(()9(" )0" 1)" :;&5>)%)50" 1)" %30;$1)" )0"

1@34&?9&0'$5"Y&9:95)"1'/A$/'0'$5"A&(0':9?'X()"1&5/"?@'5/0(9:0'$5"7*!Z"j"

c ?)/" A($4'/'$5/" (3>?)%)503)/" &4):" 5$0&%%)50" 95)" 13C'5'0'$5" 19" %$1)" 1)"

:&?:9?"1)"?&"A($4'/'$5"FHI"j"

c ?@&CC'(%&0'$5" 1)" ?&" %30;$1)" 19" A($(&0&" 0)%A$('/" :$%%)" %30;$1)"

A(3C3()50')??)"1@&%$(0'//)%)50"j"

c ?&"?'%'0&0'$5"19":;&%A"1@&AA?':&0'$5"1)"?&"A($4'/'$5"A($A()"&//9()9("j"

c ?&" :?&('C':&0'$5" 1)" ?&" 1'/0'5:0'$5" )50()" 95" :$%A?3%)50" 1)" 1$0&0'$5" )0" 95)"

/924)50'$5h""

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6" A('$('U" /)?$5" ?@&4'/" 5r" *g!!cg," 19" *a" %&'" *g!!" ()519" A&(" ?)" F$5/)'?" 1)"

5$(%&?'/&0'$5"1)/":$%A0)/"A92?':/"i"

c ?)/" :$(():0'$5/" 1@)(()9(" /9(" )G)(:':)/" &503(')9(/" '%A&:0)(&')50" ?)/" :&A'0&9G"

A($A()/")0"5$5"?)"(3/9?0&0"j"

c ?)/" :;&5>)%)50/"1)"%30;$1)/")0"1@)/0'%&0'$5/":$%A0&2?)/" '%A&:0)(&')50" ?)"

(3/9?0&0h"

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p"0):;5'Q9)"q"1&5/"?)/"(&AA$(0/"/9("?)/":$%A0)/"&559)?/h"

"

2.2.! Prsentation!des!tats!financiers!

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c 1)/"&90()/"1$:9%)50/U"2&?&5:)")0"3?3%)50/"B":&(&:0X()"291>30&'()"Y)G3:90'$5"

1)"?@H=DSZ"Q9'"5)"/)($50"A&/"/$9%'/"B":)(0'C':&0'$5h"

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"

2.3.! Les!contraintes!induites!par!le!secret!mdical!

S&5/"?)":&1()"1)"?&"43('C':&0'$5"1)"/)/"&//)(0'$5/")0"1)"?@&AA?':&0'$5"1)"/)/"


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():)00)/h"

"

Section!3! Zoom!sur!la!spcificit!du!systme!de!facturation!

3.1.! Volume!de!facturation!!traiter!lev!

=)9" 1@$(>&5'/%)/" $50" B" ?&" C$'/" 95" C$(0" 4$?9%)" 1)" C&:09(&0'$5" B" 0(&'0)(" )0" 95)"

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:$%A?3%)50&'()Zh""

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"

3.2.! Complexit!des!rgles!de!facturation!

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"

"

Figure!6!:!Processus!de!facturation!

"

.)":P:?)"C&:09(&0'$5"C)(&"?@$2O)0"1@95)"&00)50'$5"0$90)"A&(0':9?'X()"19":$%%'//&'()"

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1'CC':9?03/"'519'0)/"A&("?)/"/P/0X%)/"1@'5C$(%&0'$5")0"A&("?)"/):()0"%31':&?h"

""""""""""""""""""""""""""""""""""""""""""""""""""""""""!,"FCh"&55)G)"f&"i"A($>(&%%)"1)"0(&4&'?"/A3:'C'Q9)"19":P:?)"D):)00)/"y"F(3&5:)/"1@)GA?$'0&0'$5"

"!les!donnes!

personnelles!du!

patient

Hospitalisation

Exhaustivit,!

exactitude!et!

qualit!de!

codification

Compte"rendu!mdical

"!facturation!du!

tiers!payant,!des!

frais!de!sjour

"!Prise!en!charge

"!Radio

"!Analyse

"!Traitement

"!Chambre!particulire

Admissions

Hospitalisation

Bloc opratoireDIM

Facturation

Sortie

Partie!1,!chapitre!4!:!Aspects!comptables,!financiers!et!budgtaires!:!tats!des!lieux!et!plan!daction!!

,+"

"

!

!

Chapitre!4!Aspects!comptables,!financiers!et!

budgtaires!:!tat!des!lieux!et!plan!daction!

"

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Section!1! Le! bilan! de! la! situation! comptable,! financire! et! budgtaire!

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territoriales!des!comptes!

1.1. Les! tudes!de! la!Cour!des! comptes!:! fiabilit!des! comptes! et! situation!

financire!

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Memoire EPS