Types of Healthcare Audits and The Benefits

Auditing in the healthcare industry plays a vital role in improving the quality of patient care and services, as well as in keeping healthcare organizations in compliance with the necessary legal requirements and regulations. It is a multi-layered process which can help improve the quality of care, provide cost savings in specific areas, improve patient satisfaction, and avoid unnecessary redundancies.

We have found that, for many of our clients, quality healthcare auditing is equally vital for both payers, providers, and ultimately the patient.

A quality audit can provide observations and recommendations that will address ways to control costs, improve the quality of services, and ensure compliance with the latest regulations.

The Most Common Types of Healthcare Audits and the Benefits of Each of Them

• Random Audit

A random audit is one of the most efficient and commonly used audit types, designed to get a glimpse of the medical organization and the way it functions. The examination is done on an ad-hoc basis and does not have a known scheduled date. The purpose of a random audit is to sample a variety of different claims and compare them to relevant data and regulations.

The benefit of a random audit is that it can quickly identify whether a more systematic and detailed review is necessary to improve the way a particular provider is functioning. It offers a quick snapshot of whether there is an underlying problem that needs further investigation.

• Comprehensive Audit

Comprehensive audits do not use random sampling but, instead, a systematic review of the previously audited claims and the accompanying documentation. A complete inspection goes into more detail than the random audit.

Due to this, it is one of the most common types of audits used when specific claims are in dispute, or a particular institution is asking for a refund for a specific claim.

• Hybrid Audit

Hybrid audits are a mixture of the random and comprehensive audit approaches. During a hybrid review, the auditors select samples for both random and thorough inspections at the same time. This kind of auditing provides a better insight into different types of claims. It avoids errors missed during a random or just comprehensive audit.

The benefit of a hybrid audit is that it provides a roadmap for dealing with claims in the future and highlights the areas needing additional funding.

• Quality Improvement Audit

Quality improvement audits focus on both providers and patients at the same. It is carried out throughout the year to generate recommendations and strategies for improvement. A variety of patients with different conditions are selected and followed from the initial registration until they have returned to their original state.

During a quality improvement audit, an independent auditor will track and measure the quality of services performed, patient satisfaction, and the financial cost to both the patient and the provider in achieving the desired result.

Quality improvement audits provide a roadmap for providers on how to improve their services and provide the best possible healthcare in a cost-efficient way.

Are You Ready for Your Review?

As we have seen far too often, healthcare providers have not built audits into their practices to protect themselves and ensure the quality that they and their patients deserve. Perhaps it is time for you to consider one for your organization.

While you take care of your patients, let MGA take care of you and your practice.

Here at MGA, we provide a wide variety of assurance services that are designed to take the complexity out of auditing. You might also like to read about how we consult with other healthcare businesses and help them plan for a prosperous future.

We are here as your trusted advisors, no matter how simple or complicated your situation.

Let's talk!