This sample audit program reviews the membership and billing process within a healthcare cooperative. The objectives are to determine whether internal controls in the membership and billing processes are in place and working effectively. Specific areas of review include: group contract rates, collections, membership status, refunds, reconciliation, cash receipts, and adjustments/credits made to memberships.
This document can be used as a general guide to understand and review the membership and billing process. Organizations should continuously update and monitor the processes included in this document to ensure that it reflects business operations.