Auditing in Healthcare Project

Scenario

You are a compliance officer working at Around the Bend Clinic, an acute care facility in a rural area. Around the Bend is preparing for an audit of its revenue cycle. As a compliance officer, you are responsible for knowing about the various types of audits associated with healthcare organizations, including the components of each audit. You have been tasked with creating a training resource to prepare your coworkers for the revenue-cycle audit process.

Directions

For this project, you will create a training resource to inform staff members about an upcoming revenue-cycle audit.

Specifically, you must address the following:

• Healthcare Audit Fundamentals: To begin your training resource, you have decided to provide an overview of the different types of audits for healthcare organizations. In your overview, be sure to address the following:
  • Describe the various types of audits, both internal and external, that are applicable to healthcare organizations. In describing these elements, consider following:
    • How are internal and external audits of healthcare organizations different?
    • What are some of the common internal and external audits that you will encounter while working in healthcare organizations?
  • Describe the regulations that are associated with the various audits of healthcare organizations. Consider the types of regulations that govern both internal, as well as external audits of healthcare organizations.
• Healthcare Audit Data: In this section of your resource, you will review how data are used in healthcare audits, using a sample Third-Party Accounts Receivable Report. (SEE BELOW)  In your overview, be sure to address the following:
  • Describe how data are utilized by an organization in healthcare audits. Consider the following:
    • Which data are important to a revenue-cycle audit?
    • How are the different components of the accounts receivable report used to inform an audit?
  • Describe how to establish parameters for collecting benchmarking data in healthcare audits. Consider the following:
    • How do you determine which data are appropriate for benchmarking?
    • What should you consider when setting parameters for benchmark data?
• Healthcare Audit Billing Compliance: In this section of your resource, describe the components that make up a billing compliance plan and its role in a healthcare audit.

What to Submit

Revenue Cycle Audit Training Resource
Develop a training resource to inform staff members about an upcoming revenue-cycle audit. Your training resource should consist of a PowerPoint presentation (5–8 slides) with speaker notes (500–1,000 words) that provide necessary context for your slides.