Audit Plans

Auditing a key area of your facility? Why reinvent the wheel? Use these sample audit plans developed by experienced healthcare auditors to get started. If you don't see what you'd like today, check back for periodic updates.

Check out the free sample audit plan to see the types of tools that members of the Healthcare Audit Resource Center (HARC) can access and customize to their facility. If you are a HARC member, log in to get complete access to the Audit Plan Library. To become a member of HARC, click here. To sign up for a free trial to HARC, click here.

To suggest an audit, email us from the Contact Us page.

Featured Audit Plan: Physician Practice - Coding Free Download
Proper coding can dramatically affect reimbursement and is essential for medical-billing compliance.

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Physician practice - provider-based entity model Free Download
In recent years, physician-practice leaders have looked to alternative structures to better serve their patients while ensuring their practices remain financially stable. One model that has grown in popularity, but is not without exposure to risk, is the Centers for Medicare & Medicaid Services (CMS) provider-based entity (PBE) model. A PBE model operates as a provider-based department of a hospital. Because of the potential significant reimbursement advantages, it is essential to closely monitor these types of practices. This audit plan will help you monitor these types of practices.

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Retirement Plan Audit Free Download
This audit plan is designed to ensure compliance with the retirement plan document and Internal Revenue Service (IRS) and Employee Retirement Income Security Act (ERISA) laws and regulations governing the retirement plan.

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Excluded individuals and entities audit Free Download
Use this sample audit plan to review the organization's process for identifying excluded individuals and entities using the OIG and GSA sanction lists. The OIG imposes exclusions under §§1128 and 1156 of the Social Security Act. The Balanced Budget Act (§1128A (a) (6) of the Act; 42 Code of Federal Regulations [CFR] §1003.102(a)(2)) authorizes the government to impose civil-monetary penalties on providers and entities that employ or contract with excluded individuals or entities to provide items or services to federal-healthcare beneficiaries.

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OIG Supplemental Compliance Program Guidance for Hospitals audit Free Download
This checklist is designed to assist compliance officers in identifying specific compliance program features that the OIG has deemed to be material in its program guidance. Not every feature on this checklist needs to present in every hospital compliance program.
Additionally, hospitals and their legal counsel may disagree with various formations proposed by the OIG, and this checklist should not be taken as a wholesale endorsement of the OIG's perspective; rather, the OIG's Supplemental Compliance Program Guidance offers a useful framework that identifies the government's chief concerns when evaluating hospital compliance programs.

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Physician Contracting Free Download
Use this sample audit plan to ensure that all of your organization's contracts with physicians comply with the physician self-referral law (Stark) and the anti-kickback statute.

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Same-day readmissions
Use this sample audit plan to ensure your hospital is billing Medicare appropriately and to ensure quality patient care.

Self-administered take-home drugs
Use this sample audit to determine whether your facility is correctly billing self-administered take-home drugs.

Clinical laboratory compliance
Use this sample audit to assess the status and effectiveness of the clinical laboratory compliance program.

Rebates on cost reports
Use this sample audit to review cost reports for correct rebate information.

Post-acute care transfers
Use this sample audit to verify that your facility complies with postacute care transfer guidelines.

Stark Physician Self-Referral Law
Use this sample audit plan to verify that the hospital pays physicians fair market value for all services performed, that all compensation arrangements fit an exception to Stark, and that the hospital is not receiving prohibited referrals.

Detection and Prevention of Fraudulent Financial Reporting Audit Plan
Use this sample audit plan to detect and prevent fraudulent financial reporting.

Diagnostic testing in the ED plan
Use this sample audit plan to ensure your facility documents all diagnostic tests billed out of the emergency department (ED), and to ensure physicians interpret tests at the time of patient care.

Medical necessity monitoring plan
Use this sample monitoring plan to ensure that your facility is collecting what it deserves for Medicare-covered services and to identify items and services Medicare most often denies.

Medical necessity monitoring plan
Use this sample monitoring plan to ensure that your facility is collecting what it deserves for Medicare-covered services and to identify items and services Medicare most often denies.

Vendor gratuities
Use this sample audit to ensure that vendors are not offering gifts and gratuities to reward or induce referrals or persuade physicians to switch to particular drugs within your facility.

Self-administered take-home drugs
Use this sample audit to determine whether your facility is correctly billing self-administered take-home drugs.

Outpatient cardiac rehabilitation
Use this sample audit to very compliance with cardiac rehab regulations.

HCPCS code C8952 compliance audit
Use this sample audit to verify your facility's compliance when using HCPCS code C8952.

Cardiac rehab 2006 regulations audit
Use this sample audit to verify compliance with 2006 updates to cardiac rehab regulations.

Ambulance transports audit
Use this sample audit to verify that your hospital's requests for ambulance services meet medical necessity.

Mental Health Audit: Audit Therapy Notes For Accuracy
Use this sample audit to verify that all services provided are medically necessary, billed correctly, rendered by qualified personnel, and properly documented.

Quality of care monitoring
Use this sample audit to ensure that the facility demonstrates a high quality of care (QOC) and refrains from patient abuse, billing for services not performed, billing for unnecessary services, providing inappropriate treatment, and negligence.

Advance beneficiary notice
Use this sample audit to ensure that the facility properly obtains advance beneficiary notices (ABN) from patients for Medicare noncovered services.

Ambulatory payment classification monitoring
Use this sample audit to ensure compliance with coding and claim development laws and to prevent ambulatory payment classification (APC) reimbursement losses from improper or missing documentation and charge-capture problems.

Clinical trials
Use this sample audit to ensure that clinical research is conducted in a manner that protects the rights and welfare of human subjects, complies with applicable regulations, abides by contractual terms, and ensures the integrity of the organization throughout the clinical study.

Copayment collection
Use this sample audit to ensure that the organization maximizes collections of copayments.

Individual access to protected health information (PHI)
Use this sample audit to ensure that individuals are afforded their right to access PHI in the designated record set unless exceptions apply

Institutional review board
Use this sample audit to determine whether the institutional review board (IRB) effectively protects the rights and welfare of human subjects and meets its obligations with the federal government.

Lifetime reserve days audit
Use this sample audit to verify that your organization complies with CMS requirements for lifetime reserve days.

OIG compliance program guidance
Use this sample audit to compare the organization's compliance program with the Office of Inspector General's (OIG) compliance-program guidance for hospitals.

Medicare secondary payer billing
Use this sample audit to ensure that the hospital does not bill Medicare as the primary insurer when Medicare should be the secondary insurer and to ensure the hospital is making a good-faith effort to identify Medicare patients who have another insurance that is primary over Medicare.

Graduate medical education
Use this sample audit to ensure the accuracy of the resident full-time equivalent (FTE) counts that the hospital uses for claiming graduate medical education (GME) and indirect medical education (IME).

Physician practice internal control questionnaire
Use this sample questionnaire to determine wither your physician practice has adequate internal controls policies and procedures.

Registration process
Use this sample audit to ensure that registration staff capture key information necessary to obtain accurate reimbursement.

Business associate agreement
Use this sample audit to ensure that the hospital complies with the Health Insurance Portability and Accountability Act of 1996's standards for business associate agreements (BAA).

Payroll audits
Use this sample audit to evaluate the internal and business environment surrounding payroll, to ensure that internal controls are in place and operating effectively, and to ensure that the payroll process is efficient and effective.

Evaluation and management services
Use this sample audit to identify and assess evaluation and management (E/M) coding and documentation of risk exposure and to help improve risk-management and control systems.

Conflicts of interest
Use this sample audit to ensure that risk managers are monitoring conflict disclosures properly and adequately and to determine whether management is responding consistently to any disclosed conflicts of interest.

Diagnosis-related group audit tool
Use this sample audit to evaluate both simple and complex coding errors that affect diagnosis-related group (DRG) assignment.

Emergency Medical Treatment and Labor Act (EMTALA)
Use this sample audit to determine whether the hospital is appropriately following government regulations for caring for and transferring patients who present for treatment.

Employee access to PHI
Use this sample audit to ensure that employees access protected health information (PHI) in accordance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA) rules and the hospital's policies and procedures.

Charge-capture process
Use this sample audit to ensure appropriate charge entry in order to monitor cost saving opportunities, industry standards, and regulatory compliance.

Compliance hotline effectiveness
Use this sample audit to measure the effectiveness of the compliance hotline

Compliance program testing
Use this sample audit to review the overall compliance program, including training and reporting hotline documentation and resolution.

Admission review
Use this sample audit to evaluate the appropriateness of admissions, readmissions, and transfers.

Charge Description Master
Use this sample audit to ensure that the organization maintains and updates the chargemaster (CDM) in order to report accurate, timely charges to payers.

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