Healthcare Auditing: Protecting Patient Data And Ensuring Regulatory Compliance

Introduction:

The healthcare industry is subject to stringent regulations and faces unique data privacy challenges. This comprehensive training course on Healthcare Auditing equips participants with the specialized knowledge and skills to effectively audit healthcare organizations, ensuring compliance with regulations like HIPAA and protecting sensitive patient data. Participants will learn how to identify and assess healthcare risks, evaluate controls, conduct audits specific to the healthcare sector, and navigate the complexities of data privacy. This course bridges the gap between general audit practices and the specific requirements of the healthcare industry, empowering participants to become valuable assets in safeguarding patient information and promoting ethical healthcare practices.

Target Audience:

This course is designed for professionals involved in auditing healthcare organizations, including:

• Internal Auditors
• Compliance Officers
• Privacy Officers
• IT Auditors
• Healthcare Administrators
• Anyone working in or with healthcare organizations needing an audit perspective

Course Objectives:

Upon completion of this Healthcare Auditing training course, participants will be able to:

• Understand the unique risks and regulations within the healthcare industry, including HIPAA, HITECH, and other relevant laws.
• Identify and assess healthcare risks related to data privacy, security, and compliance.
• Evaluate the effectiveness of internal controls in healthcare organizations.
• Conduct healthcare audits using industry best practices and regulatory guidance.
• Develop audit programs and procedures for healthcare assessments.
• Understand the key requirements of HIPAA and other data privacy regulations.
• Assess data security and privacy practices in healthcare settings.
• Evaluate compliance with healthcare coding and billing regulations.
• Develop recommendations for improving healthcare operations and controls.
• Communicate healthcare audit findings effectively to management and regulators.
• Stay up-to-date with the latest trends and challenges in healthcare auditing.
• Contribute to a more secure and compliant healthcare environment.
• Enhance their understanding of healthcare risk management.
• Become a more valuable and sought-after healthcare audit professional.
• Understand how to audit different healthcare entities (hospitals, clinics, payers, etc.).

DURATION

5 Days

COURSE CONTENT

Module 1: Introduction to Healthcare and Regulatory Compliance

• Overview of the healthcare industry: key players (providers, payers, vendors), services, and challenges.
• Understanding the unique risks and regulatory landscape of healthcare.
• Key regulations and regulatory bodies governing the healthcare sector (HIPAA, HITECH, Stark Law, Anti-Kickback Statute, etc.).
• The role of auditing in ensuring compliance and protecting patient data.
• Ethical considerations in healthcare auditing.

Module 2: HIPAA and Data Privacy

• In-depth analysis of the Health Insurance Portability and Accountability Act (HIPAA).
• Understanding the HIPAA Privacy Rule, Security Rule, and Breach Notification Rule.
• Patient rights under HIPAA.
• Auditing HIPAA compliance.
• State privacy laws and their relationship to HIPAA.

Module 3: Healthcare Data Security

• Protecting patient data from unauthorized access, use, and disclosure.
• Implementing administrative, physical, and technical safeguards.
• Auditing data security controls.
• Cybersecurity risks and vulnerabilities in healthcare.
• Incident response and breach notification.

Module 4: Healthcare Coding and Billing Compliance

• Understanding healthcare coding systems (ICD-10, CPT, HCPCS).
• Auditing coding and billing practices for accuracy and compliance.
• Preventing and detecting fraud and abuse in healthcare billing.
• Reimbursement methodologies and their impact on audits.
• Compliance with coding and billing regulations.

Module 5: Auditing Healthcare Operations

• Auditing patient registration and intake processes.
• Auditing clinical documentation and quality of care.
• Auditing pharmacy operations and medication management.
• Auditing laboratory services and diagnostic testing.
• Auditing other key healthcare operational areas.

Module 6: Auditing Healthcare IT Systems

• Auditing electronic health records (EHR) systems.
• Auditing healthcare data exchange and interoperability.
• Auditing telehealth and remote patient monitoring systems.
• Auditing cloud computing and third-party risk in healthcare.
• Data integrity and security in healthcare IT systems.

Module 7: Auditing Healthcare Compliance Programs

• Developing and implementing a healthcare compliance program.
• Auditing the effectiveness of compliance programs.
• Monitoring and reporting on compliance performance.
• Investigating compliance violations.
• Working with legal counsel and regulatory bodies.

Module 8: Auditing Different Healthcare Entities

• Auditing hospitals and acute care facilities.
• Auditing physician practices and clinics.
• Auditing skilled nursing facilities and long-term care providers.
• Auditing health insurance payers and managed care organizations.
• Auditing other types of healthcare entities.

Module 9: Emerging Trends and Challenges in Healthcare Auditing

• The impact of technology on healthcare auditing (e.g., AI, machine learning).
• Auditing value-based care and population health management programs.
• Addressing cybersecurity threats and data breaches in healthcare.
• Auditing the use of mobile health (mHealth) applications.
• The future of healthcare auditing and its role in improving patient care and safety.

Training Approach

This course will be delivered by our skilled trainers who have vast knowledge and experience as expert professionals in the fields. The course is taught in English and through a mix of theory, practical activities, group discussion and case studies. Course manuals and additional training materials will be provided to the participants upon completion of the training.

Tailor-Made Course

This course can also be tailor-made to meet organization requirement. For further inquiries, please contact us on: Email: info@skillsforafrica.org, training@skillsforafrica.org  Tel: +254 702 249 449

Training Venue

The training will be held at our Skills for Africa Training Institute Training Centre. We also offer training for a group at requested location all over the world. The course fee covers the course tuition, training materials, two break refreshments, and buffet lunch.

Visa application, travel expenses, airport transfers, dinners, accommodation, insurance, and other personal expenses are catered by the participant

Certification

Participants will be issued with Skills for Africa Training Institute certificate upon completion of this course.

Airport Pickup and Accommodation

Airport pickup and accommodation is arranged upon request. For booking contact our Training Coordinator through Email: info@skillsforafrica.org, training@skillsforafrica.org  Tel: +254 702 249 449

Terms of Payment: Unless otherwise agreed between the two parties’ payment of the course fee should be done 5 working days before commencement of the training.