Audit and accounting for healthcare organisations in Ghana

A hospital's largest asset is usually a receivable from the National Health Insurance Scheme, and its largest risk is that a portion of that receivable will be rejected for reasons decided at the point of care months earlier.

Claims are won or lost at the bedside

A claim is rejected because documentation was incomplete, coding was wrong, or authorisation was not obtained, and all three happen in the clinical area rather than in finance. By the time finance sees the rejection the episode is months old and the supporting record is difficult to reconstruct. The control that matters is at capture, not at submission.

Ageing tells you what the provision should be

Claims receivable should be aged by submission date and analysed by rejection reason, so that the provision is derived from your own experience rather than from a percentage somebody chose. Where a hospital cannot say which claim types get rejected and why, the provision is a guess and the auditor will treat it as one.

The tax question nobody asks

Healthcare providers typically make a mix of exempt and taxable supplies, and where that mix exists input tax has to be apportioned. Pharmacy sales, private patient work, diagnostics for external referrals and non-clinical services all sit differently. We rarely find this apportionment done properly, and the direction of the error is usually in the Ghana Revenue Authority's favour.

Consultants

Visiting consultants engaged on a fee basis raise a genuine employment status question, and the answer determines whether PAYE should have been operated. Where a consultant works substantially exclusively at one facility on set sessions, the arrangement is worth examining before somebody else examines it.