A Primer on Healthcare Auditing: Why, Different Types and Benefits

What is Healthcare Auditing

Medical auditing is a way of ensuring that over a period of time the actions that a hospital, or other medical institution has taken are correct, that they comply with the regulations and are right for the patient or client. It is a way of ensuring that the actions of those who deliver medical care on behalf of the institutions are correct and can be trusted. An independent medical auditor will ensure that the actions of others who provide services that are crucial to the health care being delivered are correct.

Healthcare audit is a procedure of reviewing the documents, records and reports of the healthcare institutes and make sure everything is in compliance of the guidelines. The healthcare auditing is done by a group of experts who check the records and make sure that the reports and the files are updated perfectly. These auditors also check the reports and make sure that the same are not forged or duplicated.

Healthcare auditing is important for the companies/hospital entities so that HSE (Health and Safety Executive) can be informed about the fulfillment of the statutory obligations by your company with the best practices. It is important for the HSE and is a part of requirements of the QAVD, Quality, Assurance, and Verification Division. Every hospital must go through Healthcare auditing so to ensure that all the HSE policies are being followed to assure its framework.

Types of Healthcare Auditing:

Healthcare audit has a total of 4 types which are as followed:

Random Audit

Just like its name, the random audit is an unsystematic audit in which samples are reviewed by the auditors mostly, including cases with small or large amounts of money. In this type of Healthcare audit, the main focus is on the money, either spent or received by the company. This auditing is like skimping on companies for the HSE so that they have an idea of what the company is like, and if it is fine or not. If not fine, then a closer inspection of the company is in need rather than this random audit.

Comprehensive Audit

This audit comes after the random audit, but unlike the unsystematic skimping, it focuses on the things that have already been audited in the random audit and looks at those claims in a closer way. HSE uses this audit rather than the random audit if they are looking at refund cases in which money is spent. There are two ways in which one is chosen, either manually or electronically for the sample’s inspection.

Hybrid Audit

Like its name, it is a hybrid of the last two audits. In some cases, the samples are taken randomly, while in others, the samples are taken in a much more comprehensive way. The results are more accurate in this type of audit as it is a more accurate way to audit claims and different cases. Then these accurate results are used in the future so that the money spent for no reason can be compensated to the company.

Quality Improvement Audit

This audit is based upon its name. It focuses on the health of the patient and the ways to decrease the costs of the treatments while still giving the best treatment. The Healthcare audit’s main focus is on the betterment of the patient with the least cost of the treatment hence why patients before their treatment are enrolled in this audit till their treatment is done.

A Healthcare audit is beneficial for both the hospital and the patients, as it gives leads to better treatment options and their qualities. The health providers and payers can be benefited from the positive recommendations in the future.

As it is said before, this audit focuses on the ways to decrease the amount of money spent on treatments, by both the providers and the patients. The detailed analysis of this type of Healthcare auditing is the reason why hospitals understand and follow the government regulations better.

The best healthcare audit tools

The best healthcare auditing tools are mostly computer-based, for better and more accurate results.   The software provides the best tools that can help the team to configure better and make one database of all the responses to audits workflow. This is what includes in an ideal software:

Automation: Automatic tools are in dire need as humans are prone to making mistakes and manual tools in this case are not much beneficial. An automation process helps to get the task done and reduces the risks of manual errors. Automation is an integrated system specially designed for this purpose.

Standardized workflow: The software you use must be customized as per your hospital and its needs, like internal audit, technical capability, and denial process. In the HSE auditing management, there is no such thing that can fit all.

Worklist of real-time: this information is necessary so everyone knows what duty they are on, and about others’ duties as well. This will also help the team to meet the deadline and finish their tasks easily. They will also have an idea of others’ workload and respect time.

The integrity of data: the software provides accurate data, that you can confidently show to external auditors. Even if that same data has gone through multiple checking processes, you won’t be satisfied with its accuracy of it. So save your effort and time by using software so accurate results and peace of mind.

The only thing a hospital’s system needs is a software-based audit management response. This will help you be prepared for any type of healthcare auditing and will help you give an accurate and quick response with the right tools.

Benefits of Healthcare Audit

1. Identifies Improper Billing Practices

It is bound to happen that billing will be miscounted with the number of money transactions in or out of the hospital daily. You can lose your hospital’s reputation with the late billing, duplication of bills, and many more. To help you get rid of this problem, a healthcare audit is important. It will decrease the risks of billing errors, will make your hospital have greater profits, become a competition for others and have reliability.

2. Finds Coding Errors Early

It is not possible to 100% get rid of the coding errors even if you use a software-based response. Hence it is better to find these coding errors as soon as possible with the help of a healthcare auditing and correct them to your best. You can use medical audits to detect the coding errors, which include out-of-date codes, wrong data input, etc. you can get rid of the errors even before the providers can know if you use auditors who can find errors quicker than software.

3. Increases Positive Patient Experiences

If your hospital has incorrect data input or errors, your patients’ will be affected and they may qualify your hospital as useless and their loyalty will be tested. You may have to pay lots of money to get rid of the errors, but still, the patients’ trust will be broken.

Use external auditors to examine your hospital and reduce the bugging, and check the profit management so that a clearer view can be seen. This will help you save money from wasting and buy better supplies for the hospital and hence have the patients’ trust.

4. Holds Staff Accountable

This will allow you to keep a check and balance on your staff and have an accurate report of all their work and errors. You will see staff’s response to workload, documentation, and department errors. Educate yourself about your staff’s activity by the healthcare audit and ensure proper procedures and policies.

The purpose of this is not to doubt the staff, but to let them know of their responsibilities and to check and correct their mistakes in real-time. This will help your organization have fewer issues of compliance.


Health care organizations have a lot of moving parts. Doctors and nurses have a lot of responsibilities and have to navigate a complex system of insurance companies, regulatory bodies, and other healthcare providers. That’s why it’s so important to have a healthcare audit team.

This team is responsible for making sure that your organization is in compliance with all federal, state, and local laws and regulations. A healthcare audit can help make sure that your organization is doing everything it can to meet its goals and keep the community healthy.

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