Health Care Auditing and Monitoring Tools for an Effective Compliance Program

Overview

Auditing and monitoring processes help health care organizations stay compliant with federal and state rules and regulations by implementing internal checks and reviews of compliance program operations. Monitoring includes ongoing checks to ensure quality control and verify that all procedures are functioning as they should within the compliance program. Ongoing monitoring of the compliance program is conducted by Compliance Department staff, and any deficiencies discovered during monitoring may warrant additional auditing from the organization’s Internal Audit Department or an external group. External audits are usually more formal reviews that consist of identifying risk areas, assessing internal controls, testing processes, validating information, and formally communicating recommendations and corrective actions for improving compliance program operations to management and the Board of Directors. An external group or firm should conduct all auditing to ensure independence and objectivity.

Health care compliance auditing and monitoring plans are imperative for operational success because they provide in-depth reviews of the compliance program from both inside and outside the Compliance Department. These review processes ensure necessary procedures, policies, and safeguards are in place to avoid high compliance risks and to run an effective compliance program. They also verify that workforce members in the organization are aware of and properly trained on required federal and state laws as well as internal procedures and conduct.

Key Health Care Auditing and Monitoring Tools

Although health care compliance auditing and monitoring plans should be tailored to every organization based on its current operations, risks, and procedures, there are some standard auditing and monitoring tools that can help ensure the compliance program is running effectively. These tools include:

  1. Risk assessments and evaluations to determine how many and what kinds of risks exist in the organization. This helps the organization decide where to focus auditing and monitoring efforts to address the most severe risks.
  2. Compliance work plans to provide a road map of auditing and monitoring activities for the coming year.
  3. Sampling protocols to identify and review variations in ongoing monitoring from an established baseline.
  4. Computer Assisted Audit Techniques (CAATs) to provide a more in-depth analysis of the organization’s billing systems, transactions, and internal controls. CAATs also generally advance a compliance function’s auditing capabilities.
  5. Core policies and procedures to address principal risks, clarify the purpose of the compliance program, establish internal standards for compliance with laws and regulations, help communicate organizational expectations and values, and facilitate the workforce’s understanding of compliance.
  6. Health care compliance audit templates to assist the auditing firm or vendor in conducting an efficient and thorough review based on a standard set of checks.
  7. Compliance training to educate the workforce on compliance policies and procedures as well as compliance program operation protocols. This training also highlights compliance issues across the organization with focus on the issues that pose the greatest risks.

In Review

Health care auditing and monitoring tools give organizations the right resources to implement effective ongoing auditing and monitoring processes. With the help of these tools, organizations can review compliance program operations and determine high-risk areas that may need additional attention. Although monitoring may seem easier to conduct since internal managers are responsible for the task, working with an external auditing firm or vendor is just as important to maintain an effective compliance program. If both processes are part of regular compliance program maintenance, the organization is much more likely to sustain compliance with federal and …



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