• Recalculate bad debt and contractor allowance reserves
• Age receivables on date-of-service vs. invoice date to recalculate cash flow
• Age service billing dates to assess timely collections and write-offs
• Analyze rejected payments by financial class, procedure code, cost center
• Calculate average days from discharge to bill, bill to payment, by payor or department
• Calculate days in accounts receivable
• Calculate reimbursement percentages by payer
• Compare date-of-service to invoice date to identify opportunities to re-engineer charge processing
• Compare detailed aging of receivables to timing cycle required by Medicare to identify opportunities for improvements in charge processing
• Determine appropriate level of doubtful accounts reserves
• Determine average billing amount by financial class or cost center
• Determine average number of days from invoice to payment by financial class

• Analysis of payroll records for higher risk employees (nurses, pharmacists, etc.).
• Identify employees who have not taken a vacation for an extended period of time. Risk: Don’t want to be away from work because of need for drugs or “making sure to cover their tracks”.
• Identify employees with high amounts of overtime or always
   volunteer to cover a shift.
• Conversely, identify employees who have a spike in number of sick days taken.
• Trend analysis of higher risk employees and higher risk drugs/ controlled substances.
• Analysis over time of higher risk employees and use/ administering of controlled substances.
• Calculation of standard deviation of use of controlled substances compared to other employees for the same time frame.
• Test for unusually high amounts of drug wasting (standard deviation analysis).
• Identify orders of unusually high amounts of opioids/ controlled substances compared to usage.
• Compare use of controlled substances/narcotics compared to
  job description of the hospital employee.

• Determine physician contract compliance
• Evaluate physician practice history by patient type, payer, etc.
• Report on incomplete physician profiling information
• Test physicians for current accreditation
• Selectively audit new physicians for reporting compliance

• Divide inventory into classes and compare percent investment
• Identify duplicate supply items on inventory master
• Identify items with yearly volume under on-hand quantity
• Identify obsolete inventory by sorted turnover analysis
• Identify starting and ending period balances by class or group

• Compare authentication/authorization files to employee files to identify terminated employees
• Identify corrupt data fields
• Identify duplicate records
• Sort current system lists by system privilege to identify people who have more access than required for job duties (including I.S. employees)
• Compare system access to physical security logs

• Identify single day stays and subsequent readmissions
• Identify inappropriate unbundling of lab tests
• Identify frequent use of high risk organizations
• Match OIG-excluded providers list with vendor, employee master files
• Identify upcoding
• Analyze patient data access logs to identify possible HIPAA risks/violations