Comprehensive Internal Audits: Achieving Revenue Cycle Compliance
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Revenue Cycle Internal Audit
11 December 2018 - 15:50, by , in Acute, Blog, Comments off

Achieving effective and compliant healthcare functions cannot occur without well-defined and ongoing compliance auditing. Compliance audit processes serve as an integral part of hospital clinical and non-clinical departments and facilitates addressing critical business risks and compliance issues. With comprehensive internal audits, organizations can achieve and maintain compliance requirements within the patient access, documentation and charge capture, and patient financial service areas of their revenue cycle.

Internal Audit Best Practices

An internal audit program is proactive and not reactive, allowing facilities to anticipate organizational and industry risk. Internal auditors should include the following components in their audits:

  • Conducting assessments to determine risk levels
  • Understanding laws and regulations governing those areas to be audited
  • Obtaining and/or establish policies for specific issues and areas, define accountability in the policy, and develop procedures to support the policies
  • Educating on the policies and procedures and communication of key requirements
  • Monitoring of compliance laws, JCAHO, and organization’s policies and procedures
  • Auditing the highest risk areas
  • Re-educating staff on the law, policies and procedures, issues identified in the audit and corrective actions planned or taken

Additionally, well designed and thorough reports are an important piece of a compliance review. Reports should highlight the applicable regulatory changes, associated controls mapped to the new regulatory requirements, existing control assessment results, training gaps, the number of policies that require updates, risk assessments and other key data.

Benefits of Internal Audits

Implementing a comprehensive internal audit program will position a facility to actively respond to the ever-changing healthcare regulatory environment. It will increase staff confidence and morale through compliance training and knowledge and show commitment to high ethical standards that facilitate positive relation between patients’ staff and hospital community. Overall, an internal audit leads to better communication and decision making to help avoid or uncover potential problems in the future.

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