Generate an Excel workbook for healthcare internal audit: admissions, discharge billing, TPA claims, pharmacy, consumables, OT, diagnostics, doctor payouts, biomedical assets, compliance and HIS controls.
| Area | Risk | Control | Test | Evidence | Cadence |
|---|---|---|---|---|---|
| Admission and discharge | Admission, consent, discharge and billing handoffs are incomplete or delayed. | UHID, admission estimate, consent and discharge checklist controls. | Sample patient files from admission to discharge and final billing handoff. | UHID, admission form, consent, estimate, discharge summary, final bill and record tracker. | Monthly |
| Patient billing and packages | Services, room rent, implants, procedures or consumables are omitted, miscoded or wrongly discounted. | Tariff master, package master, billing cut-off and discount approval review. | Match orders, procedure notes, OT/lab records and consumable issues to bill lines. | Tariff master, package master, bill register, procedure notes, discount approval and final bill. | Monthly |
| TPA and insurance claims | Claims are rejected, short-settled, duplicated, delayed or booked without service evidence. | Pre-authorisation, claim submission checklist, denial review and receipt reconciliation. | Trace claims to pre-auth, final bill, discharge file, settlement advice and bank receipt. | Pre-authorisation, claim file, TPA portal status, denial log, settlement advice and bank receipt. | Weekly / Monthly |
| Pharmacy and consumables | Medicines, implants or consumables are issued, returned, expired or written off without billing evidence. | Batch tracking, issue-to-patient billing, return control and expiry review. | Match high-value pharmacy/implant issues to patient bills and review expiry/write-off logs. | GRN, batch ledger, issue slip, patient bill, return note, expiry report and implant register. | Monthly |
| OT diagnostics and lab | OT, lab, radiology or procedure services are performed but not billed or billed under wrong package. | Order-to-service-to-bill matching and diagnostics interface exception review. | Reconcile OT/procedure/lab/radiology completion records to billing extract. | OT register, procedure notes, lab/radiology orders, completion report, billing extract and cancellation log. | Monthly |
| Doctor payouts | Consultant payouts, revenue share, retainers or incentives differ from contract terms. | Approved contract, payout computation review, adjustment approval and TDS/GST review. | Recompute payouts for sampled doctors against contract formula and eligible revenue. | Consultant contract, payout working, procedure revenue report, adjustment approval and TDS/GST support. | Monthly |
| Cash deposits refunds receivables | Patient deposits, cash collections, refunds, waivers or credit receivables are misstated. | Daily cash count, deposit ledger review, refund approval and receivables ageing review. | Reconcile collections to bills and bank; test deposits, refunds, waivers and old receivables. | Cash count, receipt register, bank statement, deposit ledger, refund note, ageing report and approval. | Daily / Monthly |
| Biomedical assets | Medical equipment, AMC, calibration, downtime or asset tagging is unsupported. | Capex approval, asset tagging, AMC/CMC tracker, calibration and downtime log. | Physically verify selected equipment and inspect calibration, maintenance and capitalisation support. | Capex approval, invoice, installation report, FAR, asset tag, AMC/CMC contract and calibration certificate. | Quarterly |
| Compliance patient data ITGC | Licences, scheme requirements, HIS access, billing master changes or patient-data access are uncontrolled. | Compliance calendar, HIS role access, billing master approval and audit-log review. | Review licences, HIS users/leavers, tariff changes and sensitive access logs. | Licence tracker, statutory returns, HIS user list, role matrix, master change log and audit-log extract. | Monthly / Quarterly |
Use this with the hospital internal audit checklist, the RCM builder and the monitoring rules repository.
Hospital internal audit is strongest when clinical-operational evidence and finance evidence are in the same file. The workbook connects admissions, discharge, OT, lab, pharmacy, claims, collections, consultant payouts, assets and HIS access to RCM tests.
The Excel export gives auditors separate sheets for engagement scope, RCM rows, patient billing samples, TPA claims reconciliation, pharmacy and consumables, doctor payout testing, assets/compliance/ITGC and monitoring exceptions. Tailor it to facility type, state, payer mix and approved audit scope.
A CA firm is reviewing a multi-speciality hospital with IPD, OPD, diagnostics, pharmacy and TPA/insurance claims.
