Healthcare Compliance Auditing: 8 Business Tools for Effective Compliance

Andrew Moran - Writer for TBR
By Andrew Moran
Nevena Radulović - Trusted Brand Reviews Editor
Edited by Nevena Radulović

Published November 24, 2022.

A healthcare office desk with a stethoscope and a laptop

If there's one industry that endures the most bureaucratic paperwork, it's got to be the healthcare sector. The healthcare industry needs to fill in a broad array of forms to comply with rules and regulations at the federal or state level. But the thankless tasks of healthcare compliance, whether to avoid fraud or to submit claims, can easily be accomplished using the best tools available for your specific needs.

» Ensure payroll compliance: see how to avoid penalties

Types of Healthcare Compliance Audits

Before we dive into the various tools healthcare professionals can use, here are two types of healthcare compliance audits that are regularly performed:

Internal Audits

An internal audit is done through operational tasks, processes, resources, structures, and systems. Essentially, an internal audit is about assessing and improving the organization's quality management system.

External Audits

An external audit refers to evaluating specific features of a healthcare firm that improves hospital compliance programs. This kind of audit, which can apply to government and commercial insurance health entities, provides the office with an outside perspective to assess the professional standards, workflows, and domestic processes.

1. Procedural Checklists

Procedural checklists are an essential tool for healthcare compliance auditing. The checklist is used to ensure the healthcare organization follows the rules and regulations in place, and it should include a list of all items that need to be audited, along with the procedure for each of those items. The procedural checklist should be tailored to the organization's needs and based on the audited areas. Procedural checklists for healthcare organizations are different from those of a retail store or consumer organization and should include all key elements, such as medical documentation, patient health records, and healthcare billing.

A procedural checklist is useful because it helps ensure all necessary items are being audited. It can also be used as a training tool for new auditors and future audits. Checklists ensure important things aren't forgotten and that everything is accounted for.

2. Proper Compliance Planning

As compliance is an integral part of healthcare, a properly prepared compliance plan is an essential tool for effective healthcare compliance. The compliance plan should be designed to ensure the safety of both patients and healthcare workers while adhering to the governmental regulations in place for healthcare.

Ideally, a comprehensive compliance plan should include the following:

  • Written standards, procedures, and policies of conduct
  • Risk management assessments
  • Employee training plan
  • Communication strategies
  • Internal monitoring
  • Keeping abreast of regulatory changes.

3. Process Automation and Data Management

As patient volumes in healthcare are increasing at a dramatic pace, there's an increased focus on data security, patient data management, and patient privacy. To ensure healthcare organizations are prepared, it's vital to automate critical tasks related to data management and ensure any data management strategies and tools in use are highly secure. Patient data is highly sensitive, and it's imperative that healthcare organizations have a system that ensures data safety and security. Any violation of patient privacy can complicate things for the organization.

This step can help healthcare organizations minimize the risk of data leaks and breaches by ensuring effective data management strategies are in place.

4. Computer Assisted Audit Techniques (CAATs)

Computer-assisted audit techniques (CAAT) are critical for healthcare. CAAT is a method of gathering electronic records and simplifying and automating large volumes of data to ensure improved adapt analysis. CAATs make the audit process less disruptive for healthcare organizations and can reduce the time required to complete the audit. In addition, they improve accuracy and compliance, reducing the chance of error.

5. Detailed Records and Patient Information

Healthcare organizations are required to maintain detailed records and comprehensive patient information. As a result, they need effective record-keeping tools to collect and analyze this data for informed decision-making. Most healthcare organizations today are required to maintain electronic health records. Still, whichever method is in place, the important thing is to organize this information in a manner that is useful for clinicians to evaluate and refer to, much like you would when you are creating records to manage your workforce.

This might be a tedious step, but patient data is extremely valuable and critical for improving the efficiency of both clinicians and the healthcare organization itself.

» Automated payroll improves efficiency as well: see why you should ditch manual payroll

6. Risk Evaluation

Risk assessment is a very useful tool for analyzing, assessing, and setting priorities in healthcare. Risk evaluation allows healthcare organizations to identify potential hazards, risks, and threats. Once the risk assessment and identification process are complete, a healthcare organization can estimate the level of risk and identify actions that will minimize important risks.

It's important to remember that healthcare organizations are high-risk and complex, with multiple factors at play (professional, technological, and organizational). Risk evaluation is essential for patients and healthcare workers, as well as ensuring a good reputation for the healthcare organization.

7. Procedure Reviews

A procedural review is a formal, structured assessment of a system or process within a healthcare unit. The goal of this review is to identify problems and implement change to ensure continuous improvement, as well as implement an effective governance program. In healthcare, any procedure that affects patients, workers, managers, and support staff needs to be evaluated to ensure there are no safety and quality issues or security breaches.

For example, reviews of adverse patient outcomes or workplace grievances can ensure a healthcare organization delivers quality care and guarantees workforce safety and satisfaction.

This may be one of those circumstances where you can take advantage of one of the many types of PEOs (professional employer organizations).

8. Compliance Training

Healthcare is a highly regulated sector. Medical facilities generally can't operate legally without proper, in-depth healthcare compliance training. This should be an ongoing process to educate healthcare employees about their responsibilities and legal and government regulations. Such training should form an important part of the workplace culture.

In addition, healthcare compliance training is critical to ensure appropriate policies and processes are set and effectively communicated to all relevant parties. Adherence to regulations, policies, and producers is a priority in healthcare and a chief component of workers' compensation, so it's important to train the healthcare staff accordingly.


From better payroll compliance to improved office efficiencies, there are many compliance audit measures healthcare offices can enjoy to enhance their compliance efforts. Whether it's better compliance training or adopting computer-assisted audit techniques, there are many steps you can take to ensure your operations are in compliance.

» Want your payroll to function without a hitch too? Read TBR's payroll software reviews and make an informed decision.

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