STRATEGY FOR IMPROVING THE MEDICAL ACCOUNT AUDIT PROCESS IN AN IPS

This document summarizes the successful experience of a student in the Health Administration program at the National Open and Distance University during her professional internship at a first-level complexity Health Service Provider (IPS) in the city of Cúcuta, Norte de Santander, Colombia. The experience focused on internal auditing of medical accounts, a fundamental tool for ensuring that health insurance providers (IPS) bill correctly for services rendered, in accordance with contractual parameters and current regulations. Therefore, strategies must be adopted to improve the auditing processes of medical accounts at this IPS, thus optimizing the systematic review of sales invoice supporting documents, as a fundamental requirement for supporting the provision of services. The audit revealed a lack of a checklist, an essential pillar for reducing institutional reprocessing, glosses, and returns that directly affect cash flow. The improvement plan intervention was based on direct observation and daily audits to diagnose the institution's glosses, returns, reprocessing, and paper expenditure. Having identified the absence of a checklist as a fundamental strategy, a tool was created as a guide to the supporting documents needed to properly support invoices. The methodology included three phases: identification, design, and execution, which allowed for a significant reduction in findings and generated a result of great institutional value, contributing to a reliable and adequately documented audit