A growing healthcare system and a single-source consulting firm collaborated to build a world-class internal audit organization  Due to expansion a healthcare system needed to add enterprise-wide healthcare audit expertise to help its internal team improve revenue and manage risk and compliance  A strategic co-sourcing relationship with Protiviti led to improvements that helped the audit function achieve industry-leader status  

Our partnership

A growing healthcare system needed to elevate its internal audit function’s capabilities to manage risk and compliance across its U.S. operations. The client turned to Protiviti for single-source expertise in a range of healthcare risk management domains and invited other Protiviti specialty practice teams to address other risk areas across the enterprise, including compliance, IT audit and technical operations. The Protiviti team helped the client complete several high-priority risk management projects. The two organizations continue to work hand-in-hand to deliver the world-class internal audit and compliance services that the CEO envisioned.

Opportunity

The healthcare system experienced significant growth, adding locations across the U.S. However, the now de-centralized organization lacked the internal audit expertise needed to manage compliance and risk in several critical areas across their expanding enterprise. The client preferred to work with a respected single-source consultant with deep healthcare audit expertise to help them assess knowledge gaps and implement best practices. Their goal; build a world-class internal audit function to reduce risk, meet compliance obligations, maintain profit margins and optimize revenue cycle functions.

Strategic approach

The Protiviti team conducted a comprehensive assessment of the client’s internal audit program to understand where it differed from industry best practices and identify opportunities for improvement. A final report delivered to the board of directors highlighted areas that once addressed, would ensure the function had the attributes to attain world-class status: 1. Clearly defined purpose and role 2. Established governance and reporting structure 3. Qualified and skilled resources 4. Robust risk assessment and audit plan development process 5. Comprehensive and consistent audit approach 6. Robust audit and findings follow-up process

Solutions

Based on our expertise and close working relationship with the client’s internal audit team, Protiviti was engaged to assist with projects in key areas including: Revenue cycle – helped identify potential revenue opportunities within the billing function Information technology – conducted a payment card industry (PCI) program review, and external penetration testing to expose and analyze cybersecurity vulnerabilities Compliance –reviewed processes and practices for several programs, plus select Centers for Medicare & Medicaid Services’ (CMS) conditions of participation (CoPs).  Finance – reviewed processes for compliance with 501(r) tax-exempt hospital regulations

Technology-driven innovation

Data-driven analytics identified potential revenue opportunities within the billing function External penetration testing identified and analyzed the impact of cybersecurity vulnerabilities

Results

Through our collaboration this healthcare provider is now characterized by a risk-based approach for audit and compliance, better corporate governance, and enhanced subject-matter expertise. With our help the client completed several high-priority risk management projects and significantly raised the maturity of its compliance function.

A co-sourced partnership with Protiviti brought this growing healthcare system the needed industry knowledge and proven internal audit expertise to address its risk challenges and revitalize its internal audit function. After a comprehensive assessment, the Protiviti specialty practice teams applied their expertise in a range of healthcare risk management domains across the enterprise, including compliance, IT audit and technical operations. The organization has gained a trusted adviser in Protiviti — an invaluable relationship in an industry characterized by constant regulatory pressure and change.

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