A Smart Audit Teaching Case Using CAATs for Medicare

Risk is inherent at all levels of hospital management such as determining healthcare service priorities, purchasing new medical equipment, patient safety, clinical governance, etc. The effectiveness of an audit process in reducing risk is a critical success factor in hospital management. Since hospital data is becoming increasingly larger, the data may be too large for auditors to handle. Consequently, they need to learn a new skill and knowledge to face the digital transformation era. The era of intelligent audit technology has arrived. In the future, auditors can use big data analysis and technology to get the assistance of advanced audit analysis tools. This paper introduces a smart audit case using diagnosis-related group (DRG) data. It explains how to use computer-assisted audit techniques (CAATs) to develop the predictions of DRGs as a starting point, triggering students to analyze the editing of DRG codes in depth by using a machine-learning model to pre-audit the accuracy of inpatient DRGs’ drop point in Health Insurance Declaration forms.