5 Audit Compliance Strategies for Hospitals with Multiple Facilities

Hospitals face many internal obstacles and workplace issues in hospital audit management and response. But in large health systems, run-of-the-mill problems are multiplied by ten. There are simply more people, departments, audits, regulations, and revenue dollars at risk.

Compliance in healthcare isn't just a nice-to-have. Federal regulatory bodies require it, and the Patient Protection and Affordable Care Act (ACA) mandates it. 

What is a Healthcare Compliance Audit?

Healthcare compliance audits are systematic evaluations. They ensure providers adhere to regulatory requirements, industry standards, and internal policies. They encompass various aspects of healthcare operations. Essential elements include billing practices, patient care, data security and administrative procedures.

These audits identify areas of non-compliance and improve the overall quality of care. However, they can be highly complex. They require heavy use of internal resources to collect and submit required documentation. Many providers fail audits precisely because they fail to prepare.

In 2023, the Department of Justice reported that “settlements and judgments under the False Claims Act [FCA] exceeded $2.68 billion in the fiscal year ending Sept. 30, 2023.” This was the most settlements and judgments the department had ever seen since the FCA was strengthened in 1986. 

Hospitals with multiple facilities must take special care to avoid becoming part of this statistic. These practices must have the proper tools to handle high volumes of external audit requests. The following strategies can help create a robust audit response system. 

1. Standardization Across All Facilities

Standardizing compliance practices across all facilities within a healthcare organization is essential. This helps maintain consistency and reduce errors. 

Create a Compliance Committee Led by a Chief Compliance Officer

A successful compliance program begins with solid leadership. Establish a compliance committee led by a Chief Compliance Officer (CCO). This step ensures that experienced and knowledgeable individuals guide compliance efforts and establishes that management is taking compliance seriously.

The committee should include representatives from various departments. These representatives can provide diverse perspectives and comprehensive oversight. The CCO and committee will develop, implement and track compliance policies and procedures.

Establish Written, Unified Policies & Procedures

Having written, unified policies and procedures is fundamental. These policies standardize compliance across all facilities. These documents should outline the organization's expectations about compliance and provide detailed instructions for staff to follow.

Every site should have the same policies and training. They should also have the same consequences for employees who fail to follow these standards. Standardizing these guidelines helps providers ensure every facility operates under the same rules. This strategy reduces variability and promotes consistent compliance practices.

Develop Real-time Work Lists

Real-time work lists are essential tools for managing compliance tasks and ensuring the timely completion of required activities. They help track ongoing compliance efforts, assign responsibilities, and track progress.

These lists will help meet deadlines, allow audit case managers to focus on the team’s work and enable the reassignment of tasks as needed. Providers should also expect to reduce time spent creating and reviewing work lists.

Clear Communication With Everyone Involved

Clear and consistent communication is essential & helps your staff & team understand their roles and responsibilities regarding compliance and fosters a culture of accountability. Regular meetings, updates, and training sessions help keep everyone informed and engaged.

2. Leverage Technology & Automation

Leveraging technology and automation can significantly enhance healthcare compliance audits. Automated systems streamline processes, reduce manual errors and provide comprehensive reporting capabilities. Advanced solutions can even manage the audit lifecycle from request to denial management. 

Automation for Better Efficiency

Manual processes and disparate tools can hinder providers. They often have to rely on valuable clinical resources to complete data entry tasks instead of working on the specifics of the appeal or denial. Non-integrated systems can also require significant "monitoring" of billing systems and information. This extra attention is needed because data feeds of claims and remittances are not automated.

Automation tools can handle repetitive and time-consuming tasks. As a result, staff is free to focus on more complex compliance issues. Automated systems can schedule audits and generate alerts for upcoming tasks. They can also ensure that all necessary documentation is collected and reviewed. Automation reduces the burden of manual processes via standardized workflows, improving efficiency and allowing for more thorough compliance oversight.

Comprehensive Reporting

Comprehensive reporting capabilities are essential for effective compliance management. In-depth reports provide incredibly useful insights into the organization's compliance status and highlight areas that need improvement. A technology-based solution provides real-time data benefits operations and analytics. This can help establish a numbers-driven system for process improvement. Decisions are based on deep data review and analysis.

Improved Data Integrity

Improved data integrity reduces the risk of errors and enhances the reliability of audit findings.  It reduces time spent running reports and validating data with financial reporting teams. Data integrity also reduces the resources required to execute reporting requirements.

Scalable Solutions Make Transitions Easier

Any solutions should be scalable to support organizational expansion and onboarding new facilities. Scalable systems can easily adapt to new requirements. This adaptability makes transitions smoother and less disruptive. Scalable solutions help expand to new facilities or implement new regulatory standards. These tools ensure compliance efforts remain consistent and effective. They provide an easy and painless transition for the end-users.

3. Continuous Training and Education

Audit response success depends almost entirely on an organization’s staff. Management must effectively communicate why audits matter to their job success. They must also show how they can individually contribute to success. Ongoing training and education help maintain a high level of compliance within practices.

Maintain Relevant Policies & Procedures

Treat your policies and procedures like living documents. They should be regularly reviewed and updated. These updates should reflect changes in regulations, industry standards and organizational practices. Regular updates prevent compliance gaps and ensure the organization is always ready for audits.

Ensure Staff Training is Always Up-To-Date

Training is never “one-and-done.” Regular training ensures staff knows the latest policies, procedures and regulatory updates. They should always know where to access the most relevant and updated information.

Make sure you provide specific training programs for every unique role within your healthcare organization. This strategy ensures all employees receive the information they need to maintain compliance. Up-to-date training helps mitigate risks and fosters a culture of compliance.

4. Compliance Enforcement and Corrective Actions

All employees must understand what the organization expects of them regarding audit response. There may be consequences if they consistently fail to follow these expectations, as in any role. 

Enforcing compliance standards and implementing corrective actions when necessary are critical. These measures ensure that identified issues are addressed promptly. They also help the organization continuously improve its compliance efforts.

Enforce the Standards You Establish

Healthcare organizations must hold staff accountable for not adhering to policies and procedures. Regular internal audits and monitoring activities help identify deviations from standards. Appropriate disciplinary actions should be taken when necessary. Doing so reinforces the importance of compliance.

Put Corrective Action Plan in Place

Implement a corrective action plan (CAP) when compliance issues are identified. This plan will address and resolve the problems. A CAP outlines the steps needed to correct the issue, assigns responsibilities and sets deadlines for completion. Following a structured approach to corrective actions addresses compliance gaps and prevents recurrence.

Regular Internal Audits & Reviews

Regular internal audits and reviews are essential. They identify potential compliance issues before they become significant problems. These proactive measures help healthcare organizations maintain high standards. They also help practices continuously improve their compliance efforts.

Perform Routine Internal Audits

Routine internal audits allow healthcare organizations to assess their compliance status. They also help identify areas for improvement before they become an issue in a real audit. These audits should be conducted regularly and cover all aspects of the organization's operations.

Benchmark & Measure Compliance Program Performance

Outline & confirm the most important key performance indicators (KPIs) and over time, regularly review their progress. Benchmarking against industry standards and best practices provides valuable insights. They reveal areas where the organization excels and areas that need improvement.

Execute Periodic Risk Assessments

Periodic risk assessments help identify potential compliance risks and vulnerabilities within the organization. These assessments should evaluate various factors. Important elements include regulation changes, operational practices and emerging threats. These assessments may be completed by a compliance committee or other leadership team members. 

Healthcare Audit Software

Implementing these strategies helps prevent legal and financial penalties. They also foster a culture of excellence and continuous improvement. Staying proactive and adaptable in compliance efforts will ensure long-term success.

Use Audit & Denial Tracker to keep your hospital system compliant and efficient during the audit process. Audit & Denial Tracker is a robust audit management and response platform. This tool is tailored for hospitals and health systems with multiple facilities. Audit & Denial Tracker harnesses the power of advanced technology. It simplifies audits, ensures consistent standards at all locations, and enhances data integrity. 

Don’t let the complexities of compliance slow you down—discover how Audit & Denial Tracker can streamline your audit management. 

Click here to learn more and elevate your organization’s audit processes.