Guidance on internal audit for hospital

Hospital internal audit is a specialised area. Here are the key areas to cover:

1. Revenue Audit:
- OPD/IPD billing accuracy — verify charges against tariff card
- Pharmacy sales reconciliation with stock consumed
- Lab/radiology revenue vs test reports generated
- Insurance/TPA claims — billing accuracy, claim submission timelines, rejected claims follow-up
- Cash collection controls — daily cash reconciliation, cashier accountability

2. Pharmacy and Drug Management:
- Stock verification — physical vs system (narcotic/controlled substance register mandatory)
- Expiry date checks — expired drug policy compliance
- Supplier invoice vs GRN vs purchase order matching
- High-value drug consumption vs patient records

3. Patient Care and Clinical Audit:
- Patient admission/discharge records completeness
- Consent forms for surgeries/procedures
- Medical record completeness (case sheets, investigation reports)
- Infection control compliance

4. Fixed Assets and Biomedical Equipment:
- Asset register maintenance — equipment additions, disposals, transfers
- AMC (Annual Maintenance Contract) compliance for critical equipment
- Calibration certificates for diagnostic equipment

5. HR and Payroll:
- Doctor/consultant fee calculations vs agreements
- Visiting doctor fee vouchers — TDS compliance (Section 194J)
- Attendance and overtime records

6. Purchases and Stores:
- Purchase committee approval for high-value items
- Vendor empanelment and rate contract compliance
- Consumables and surgical items consumption vs patient count

7. Regulatory Compliance:
- NABH accreditation standards adherence
- PCPNDT Act compliance (for hospitals with ultrasound)
- Biomedical waste management records
- Drug licence and clinical establishment registration validity

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soundarya

Aashok Kumar Sharma

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