In developing an internal audit review program, which risk area should be targeted for audit?

The Chargemaster description is the most pertinent area to target for audit in an internal review program. This is because the Chargemaster serves as a critical component of the revenue cycle for healthcare organizations, as it outlines all billable services and the corresponding charges. An accurate and comprehensive Chargemaster is essential to ensure that coding of services is correct, billing is accurate, and revenue is maximized.

Auditing this area helps identify discrepancies, such as potential undercharging or overcharging for services rendered, which can have significant financial implications and affect compliance with regulations. Additionally, inaccuracies in the Chargemaster can lead to issues with reimbursement from insurers and pose a risk of audits from external parties, particularly if there is a suspicion of billing inaccuracies.

While auditing patient demographics, staff performance evaluations, and financial assistance programs are important for overall organizational effectiveness and compliance, these areas typically do not carry the same level of financial risk and potential for revenue loss as the Chargemaster descriptions do. In the context of an internal audit, focusing on the Chargemaster aligns well with the priorities of safeguarding financial integrity and ensuring compliance with billing standards.