Despite your best efforts in meeting healthcare compliance requirements, errors may still occur. Maintaining the security and integrity of sensitive information and preventing waste, fraud, and abuse is essential to quality healthcare and promoting workplace safety. However, when a mistake occurs or you’re targeted for a random healthcare audit, it pays to be ready.
We’ll explore the various types of healthcare audits. We also discuss how compliance software can help ensure regulatory compliance and maximize efficiency and accuracy in all your compliance activities.
What is an Audit in Healthcare?
A healthcare audit is a chance for accountability and identifying errors, discrepancies, or deficiencies in practices or documentation that could lead to non-compliance and adversely affect patient care. Moreover, a healthcare audit uncovers factors contributing to errors and provides opportunities to correct mistakes and improve existing systems and practices.
While few people enjoy the thought of undergoing an audit, this process can be informative and beneficial for a healthcare organization. For example, internal audits help compliance officers and executives maintain operational efficiency, reduce errors, improve workflows, and enhance the bottom line.
When considering what an audit in healthcare entails, it helps to think of it as a four-step cycle:
- Deciding the focus of the audit, such as operational or care quality improvement
- Establishing audit criteria
- Collecting relevant data
- Conducting data analysis and comparing results to existing compliance standards
Following these steps ensures that auditors conduct their investigations impartially and accurately.
Types of Healthcare Audits
A healthcare organization typically faces many types of audits, which can be classified as internal or external.
Internal Audits
An internal audit aims to identify areas for improvement within the organization to ensure compliance with healthcare regulations. An organization usually designates a staff person to act as an internal auditor. An internal audit is an excellent opportunity to detect factors contributing to non-compliance, mitigate risk, and address potential problems.
Compliance officers and high-level leaders may call for any of the following types of internal audits:
- Clinical audit: Identifies necessary improvements in practices related to patient care.
- Coding and documentation: Assesses the accuracy and completeness of medical documents and billing codes.
- Financial audit: Determines the accuracy of the organization’s financial statements and records and its compliance with financial laws, internal or external.
- Operational audit: Consists of an exhaustive evaluation of systems and processes that contribute to the organization’s business performance.
- Privacy and security: Assesses the organization’s infrastructure security and information privacy and the extent to which they comply with Health Insurance Portability and Accountability Act standards.
- Quality improvement audit: Investigates the patient experience and identifies and implements improvements in care.
External Audits
An external healthcare audit ensures an unbiased assessment of the organization’s compliance with healthcare regulations. When a governmental agency orders an external audit, it seeks to evaluate a facility’s operations objectively to ensure it complies with healthcare laws and standards. An outside auditor, usually a contractor from an independent firm, will conduct the external audit.
Most hospitals and other healthcare organizations can expect an annual external audit. The U.S. Office of Inspector General in the Department of Health and Human Services maintains oversight over healthcare audits at the federal level. The types of external audits that organizations can expect include:
- Commercial payer audits: Evaluation from a commercial payer to investigate billing codes, the organization’s billing or coding practices, or compliance with payer regulations.
- Third-party expert audits: Specialized investigation by an auditing firm to look into specific compliance aspects, such as cybersecurity, financial operations, or specific clinical practices.
- Federal government audits: Assessment from an agency like the Centers for Medicare and Medicaid Services (CMS) to ensure compliance with federal funding programs.
Get Healthcare Audit Solutions From Compliance Software
When facing an internal or external audit, keeping track of the necessary documentation and proving compliance with complex regulations is difficult. Fortunately, compliance service providers like Compliancy Group offer software to help you prepare for an audit and perform other crucial tasks.
With the right software, you can prepare for and handle any healthcare audit like a pro. A comprehensive software package from Compliancy Group will help you track the progress of your audit and make it easier for you to:
- Keep track of standards across various sets of healthcare regulations
- Manage, store, share, and create documents
- Simplify information retrieval
- Conduct risk assessments and report the results
- Set alerts of regulatory changes
- Send training renewal reminders
- Streamline incident reporting
- Document corrective actions resulting from previous audits
- Automate administrative functions
At Compliancy Group, we provide healthcare audit solutions for various organizations. Before facing your next healthcare audit, contact Compliancy Group today to learn how to make the process easier for your organization.
