Updated 11/20/2023

Achieving effective and compliant healthcare functions cannot occur without well-defined and ongoing compliance auditing, especially for revenue cycle audits. Healthcare organizations often fall victim to losing significant revenue due to operational and workflow issues within their revenue cycle department and other related departments. Clinical documentation issues, lack of communication among departments, and other operational challenges are often the cause of missed revenue opportunities.

Auditing to Identify Risks & Compliance Issues

Compliance audit processes serve as an integral part of hospital clinical and non-clinical departments and facilitate addressing critical business risks and compliance issues. With comprehensive internal audits, healthcare organizations can achieve and maintain healthcare regulatory compliance requirements within the patient access, documentation and charge capture, and patient financial service areas of their healthcare revenue cycle.

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Internal Audit Best Practices for Healthcare Organizations

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

  • Conducting assessments to determine risk levels (such as a thorough review of the organization’s medical billing documentation compliance)
  • Understanding laws and regulations governing those areas to be audited
  • Obtaining and/or establishing policies for specific issues and areas, defining accountability in the policy, and developing procedures to support the policies
  • Educating on the policies and procedures and communication of key requirements
  • Monitoring of healthcare regulatory 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
  • Evaluating how the revenue cycle department communicates with/impacts other departments in the organization

Additionally, well-designed and thorough reports are an important piece of a compliance review for healthcare revenue cycle improvement. 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.

McBee’s Internal Auditing Services

Benefits of Internal Auditing in Healthcare Organizations

Internal audits serve as an integral part of a healthcare organization’s operations and facilitate addressing critical business risks and compliance issues. Implementing a comprehensive internal audit program will position a facility to actively respond to the ever-changing healthcare regulatory environment. They will increase staff confidence and morale through healthcare regulatory compliance training and show commitment to high ethical standards that facilitate positive relations between patients’ staff and the hospital community. By pinpointing areas that need operational improvement, internal audits can also lead to implementing revenue cycle process improvement steps that result in better efficiency. Overall, an internal audit leads to better communication and decision-making to help avoid or uncover potential problems in the future.

McBee’s Approach to Achieving Internal Compliance

Whether clinical or financial, McBee’s systematic, disciplined approach to achieving internal compliance is tailored to your specific goals. With our internal audits and mock surveys, we identify potential pitfalls and make detailed recommendations to optimize your current compliance plan or implement a new one. We prepare you for regulatory changes and reduce the risk of receiving future audits. Paired with our compliance education sessions, our internal audits increase staff confidence and knowledge to ensure organizational and regulatory risk is mitigated. Learn more about our internal audit services or contact us for more information on outsourcing revenue cycle or internal audit operations.

Contact McBee to streamline internal auditing in your healthcare organizations to achieve compliance today.

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