Evaluate internal controls over the pharmacy revenue cycle
6
Select sample invoices for audit
7
Verify accuracy of invoice details
8
Audit medication cost and pricing process
9
Review payment collections process
10
Verify adherence to reimbursement policies
11
Review denial management strategy
12
Audit pharmacy patient registration process
13
Evaluate billing fraud and leakage controls
14
Analyse financial reporting of pharmacy revenue
15
Draft preliminary audit report
16
Discuss preliminary findings with pharmacy staff
17
Approval: CFO
18
Develop action plan for improvements
19
Finalize audit report
20
Present audit findings to management board
21
Approval: CEO
Identify team members for audit
This task involves identifying the team members who will be responsible for conducting the internal audit of the pharmacy revenue cycle. The team members will play a crucial role in ensuring the accuracy and effectiveness of the audit process. The desired result of this task is to have a well-rounded team with diverse skills and expertise to perform the audit. Do you have a team in mind for this audit? Who would be the best fit for this role? What challenges do you anticipate when selecting team members? What resources or tools will be needed to complete this task?
Review audit objectives and scope
In this task, the audit objectives and scope will be thoroughly reviewed. This is an essential step to ensure that the audit process remains focused and aligned with the goals of the pharmacy revenue cycle. The impact of this task is significant as it sets the direction for the entire audit. Have the audit objectives and scope been clearly defined? What are the main objectives of this audit? What challenges may arise when reviewing the objectives and scope? What resources or tools will be needed to complete this task?
Draft audit plan
This task involves drafting an audit plan that outlines the approach and methodology to be used during the audit process. The audit plan plays a crucial role in ensuring the efficiency and effectiveness of the audit. The desired result of this task is to have a well-structured plan that covers all necessary areas of the pharmacy revenue cycle. What are the key elements that should be included in the audit plan? What challenges may arise when drafting the audit plan? What resources or tools will be needed to complete this task?
Approval: Pharmacy Director
Will be submitted for approval:
Draft audit plan
Will be submitted
Evaluate internal controls over the pharmacy revenue cycle
This task involves evaluating the internal controls that are in place to ensure the accuracy and integrity of the pharmacy revenue cycle. The evaluation of internal controls is essential to identify any weaknesses or gaps that may exist. The desired result of this task is to have a comprehensive assessment of the internal controls. What are the main internal controls in place for the pharmacy revenue cycle? How do these controls contribute to the overall efficiency of the process? What challenges may arise when evaluating internal controls? What resources or tools will be needed to complete this task?
1
Documentation
2
Segregation of Duties
3
IT Systems
4
Policies and Procedures
5
Monitoring and Oversight
Select sample invoices for audit
This task involves selecting a representative sample of invoices from the pharmacy revenue cycle for audit purposes. The selection of the sample invoices should be done in a systematic and unbiased manner. The desired result of this task is to have a sample that accurately represents the overall population of invoices. How will the sample invoices be selected? What factors will be considered when selecting the sample? What challenges may arise when selecting sample invoices? What resources or tools will be needed to complete this task?
Verify accuracy of invoice details
This task involves verifying the accuracy of the details mentioned in the selected invoices. It is important to ensure that all the information provided in the invoices is correct and aligned with the pharmacy revenue cycle. The desired result of this task is to have accurate and reliable invoice details. How will the accuracy of the invoice details be verified? What challenges may arise when verifying the accuracy of invoice details? What resources or tools will be needed to complete this task?
1
Check for correct patient information
2
Verify medication details
3
Confirm pricing and discounts
4
Validate payment information
5
Cross-check with pharmacy records
Audit medication cost and pricing process
This task involves auditing the medication cost and pricing process of the pharmacy revenue cycle. It is essential to ensure that the medication costs and pricing are accurate, transparent, and compliant with regulatory requirements. The desired result of this task is to have a comprehensive assessment of the medication cost and pricing process. How will the medication cost and pricing process be audited? What challenges may arise when auditing the medication cost and pricing process? What resources or tools will be needed to complete this task?
1
Pricing accuracy
2
Discount calculations
3
Comparative analysis with competitors
4
Compliance with regulatory requirements
5
Transparency in pricing
Review payment collections process
This task involves reviewing the payment collections process of the pharmacy revenue cycle. It is important to ensure that the payment collections are performed efficiently and accurately. The desired result of this task is to have a clear understanding of the payment collections process. How will the payment collections process be reviewed? What challenges may arise when reviewing the payment collections process? What resources or tools will be needed to complete this task?
Verify adherence to reimbursement policies
This task involves verifying the adherence to reimbursement policies in the pharmacy revenue cycle. It is important to ensure that the reimbursements are aligned with the established policies and procedures. The desired result of this task is to have a comprehensive assessment of the reimbursement process. How will the adherence to reimbursement policies be verified? What challenges may arise when verifying adherence to reimbursement policies? What resources or tools will be needed to complete this task?
1
Review reimbursement policies
2
Evaluate reimbursement claims
3
Identify discrepancies
4
Confirm compliance with policies
5
Recommend improvements
Review denial management strategy
This task involves reviewing the denial management strategy of the pharmacy revenue cycle. It is important to have an effective denial management strategy in place to minimize the impact of claim denials. The desired result of this task is to have a clear understanding of the denial management strategy. How will the denial management strategy be reviewed? What challenges may arise when reviewing the denial management strategy? What resources or tools will be needed to complete this task?
Audit pharmacy patient registration process
This task involves auditing the pharmacy patient registration process. It is important to ensure that the patient registration process is efficient, accurate, and compliant with regulatory requirements. The desired result of this task is to have a comprehensive assessment of the patient registration process. How will the patient registration process be audited? What challenges may arise when auditing the patient registration process? What resources or tools will be needed to complete this task?
Evaluate billing fraud and leakage controls
This task involves evaluating the billing fraud and leakage controls that are in place within the pharmacy revenue cycle. It is important to identify any loopholes or weaknesses in the controls to prevent fraudulent activities and revenue leakage. The desired result of this task is to have a comprehensive assessment of the billing fraud and leakage controls. How will the billing fraud and leakage controls be evaluated? What challenges may arise when evaluating these controls? What resources or tools will be needed to complete this task?
Analyse financial reporting of pharmacy revenue
This task involves analyzing the financial reporting of the pharmacy revenue. It is important to ensure that the financial reports accurately reflect the financial performance of the pharmacy revenue cycle. The desired result of this task is to have a clear understanding of the financial reporting. How will the financial reporting be analyzed? What challenges may arise when analyzing the financial reporting? What resources or tools will be needed to complete this task?
Draft preliminary audit report
This task involves drafting a preliminary audit report that summarizes the key findings and observations from the audit process. The preliminary audit report provides an initial overview of the audit results. The desired result of this task is to have a well-structured and informative preliminary audit report. How will the preliminary audit report be drafted? What challenges may arise when drafting the report? What resources or tools will be needed to complete this task?
Discuss preliminary findings with pharmacy staff
This task involves discussing the preliminary findings of the audit with the pharmacy staff. It is important to communicate the findings in a clear and constructive manner. The desired result of this task is to have an open and productive discussion with the pharmacy staff. How will the preliminary findings be communicated to the staff? What challenges may arise when discussing the findings? What resources or tools will be needed to complete this task?
Approval: CFO
Will be submitted for approval:
Discuss preliminary findings with pharmacy staff
Will be submitted
Develop action plan for improvements
This task involves developing an action plan to address the identified areas of improvement based on the audit findings. The action plan should outline specific actions, responsibilities, and timelines for implementation. The desired result of this task is to have a comprehensive and actionable plan for improvements. How will the action plan be developed? What challenges may arise when developing the plan? What resources or tools will be needed to complete this task?
Finalize audit report
This task involves finalizing the audit report after incorporating any additional feedback or information. It is important to ensure that the audit report is complete, accurate, and well-structured. The desired result of this task is to have a finalized audit report ready for presentation. How will the audit report be finalized? What challenges may arise when finalizing the report? What resources or tools will be needed to complete this task?
Present audit findings to management board
This task involves presenting the audit findings to the management board of the pharmacy. It is important to effectively communicate the key findings, recommendations, and action plan to the management board. The desired result of this task is to have a successful and impactful presentation to the management board. How will the audit findings be presented? What challenges may arise when presenting the findings? What resources or tools will be needed to complete this task?
