Internal Audit of Hospital Checklist

Conducting regular internal audits enables hospitals to quickly identify compliance failures and key risks before state or federal regulators detect them, something especially helpful for hospitals experiencing difficulties with their healthcare compliance programs.

At a hospital, it is equally essential to ensure that administrators and compliance officers are aware of and respond swiftly to new compliance obligations that arise, using an internal audit checklist for hospital.

Medical Billing Audit Checklist
Healthcare can be fraught with mistakes. A widely shared article by surgeon Atul Gawande in The New Yorker demonstrated how an easy checklist helped one hospital reduce infection rates to near zero, just as regular audits can uncover problems, educate staff members on best practices and eliminate improper payments altogether.

Medical billing audits don’t just check to make sure all procedures are correctly coded; they also verify if patient records match insurance claims, as part of a critical part of their audit process to ensure all services and treatments provided by a medical practice are documented properly and help avoid under- and over-coding, coding exceptions, unbundling of services and upcoding.

An effective medical billing audit can protect a practice from malpractice lawsuits, Medicare payment issues and costly fees for incorrect submittals. But conducting one requires careful planning and preparation – in addition to supervision by an independent team of experts free from potential conflicts of interest.

Medical Records Audit Checklist
Medical records audits are comprehensive reviews that examine every step in a healthcare facility’s patient records from start to reimbursement, such as coding accuracy, documentation, medical necessity substantiation and any revenue cycle management issues which might lead to denials or reimbursement challenges with payers.

An audit can focus on specific service items, providers or diagnosis codes depending on the nature of a healthcare facility, providing for an in-depth screening without taking too long.

An effective medical records audit starts with clearly defining its scope and target area, for instance focusing on initial office visits, consultations or services billed to Medicare or Medicaid. A sample size must also be carefully considered to prevent distorting results; comprehensive audits include checking charts for legible identification; past medical histories may include allergies or adverse drug reactions recorded as well as smoking, alcoholism or substance abuse documented as part of a comprehensive audit process.

Patient Safety Audit Checklist
Studies have demonstrated the power of checklists to reduce medical errors and enhance patient safety. One such checklist tool, introduced through the Keystone ICU project, led to a decrease in central line infections across multiple centers through comprehensive auditing tools.

Hospital staff can use checklists to assess if safety practices are in place and identify areas for improvement. A surgical safety audit checklist, for example, can ensure staff members complete specific pre-operation procedures prior to placing a patient into an operating room.

An effective internal audit must cover every aspect of a hospital facility, or else critical information could go undetected during inspection by state and federal authorities, placing fines or penalties at risk. A comprehensive safety inspection ensures all potential hazards are identified and addressed as quickly as possible.

Patient Education Audit Checklist
Assemble a team capable of conducting audit procedures efficiently without becoming overwhelmed. Schedule the medical audit during less hectic times, communicating the purpose and benefits to all staff members involved.

Utilizing an audit structure with a nursing audit checklist can assist teams in efficiently conducting reviews. A mobile app that enables multiple team members to collaborate on creating comprehensive reports as they go and automatically saving them in the cloud may also prove helpful in expediting the review.

Conducting internal audits takes discipline and commitment from hospitals. They must ensure the audit is comprehensive and does not overlook any relevant information; otherwise state or federal authorities could find out about this oversight during an external review of their facilities.

Hospitals should consult with outside counsel in order to stay abreast of any new compliance obligations that could impact their operations and incorporate those into existing compliance programs and internal audit procedures.