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Report by Edward FRIMPONG
The National Health Insurance Authority (NHIA) in collaboration with the United States Agency for International Development (USAID) has organized a two-day training program aimed at improving the skills and knowledge of internal and external clinicians on clinical and compliance audit revised methodology and tools.
The training program, which was held in Aburi, brought together a selected group of staff from the authority who serve as internal clinical auditors and some external clinical auditors.
The first day of the program focused on the enhanced clinical audit methodologies, Benefits Package, and Medicines list, Practical Session on Data collection tools, and Code of conduct/ confidential agreement.
Mr. Eugene Kwofie, one of the trainers, guided the participants through the complicated realm of clinical and audit procedures, providing them with the tools they needed to confront complex challenges. He emphasized the importance of maintaining high standards of clinical practice, highlighting the significance of adhering to evidence-based guidelines, ensuring patient safety, and delivering quality care.
The Deputy Director for Quality Assurance Directorate Mr. William Omane Agyekum went through the red flags associated with auditing claims that are submitted to the Authority. He emphasized the importance of being vigilant and thorough in identifying potential issues or irregularities that may arise during the auditing process.
One of the key red flags he discussed was inconsistency in the information provided. This could include unusually high or low claims amounts submitted. This, he added, could indicate potential fraud or errors. Mr. Agyekum stressed the need to carefully cross check all the data to ensure accuracy and to flag any inconsistencies for further investigation.
Mr. Carl Engman led participants in the practical session of the training on data collection tools, while Mr. Festus Baah also took trainees through the code of conduct and confidential agreement for newly sworn in clinical auditors for the NHIA. He emphasized the importance of upholding the highest standards of integrity, honesty, and professionalism in carrying out their duties. He also highlighted the need for confidentiality and the protection of patient information in compliance with the NHIA guidelines and regulatory requirements.
The participants expressed their appreciation to the NHIA and the USAID for organizing such a training program. They noted that the training program was timely and relevant, as it has provided participants with the necessary knowledge and skills required to effectively perform their roles as internal and external clinical auditors.
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