Medical Audits

To perform Medical Audits is the institutional practice responsible for monitoring that the standards that are set by our current legislation and commitments with insurance companies are being met. These standards are founded by the guiding principles of evidence-based medicine, in a way that allows institutions to make improvement plans that guide the insurance-clinic-patient relationship to Safe and High-Quality clinic practices.

Inside La Clínica El Rosario, the designated medical audits team carries out the activities related to: Concurrent audits (those that deal with patient treatment); direct reconciliations with external audits about raised objections regarding the billing of medical services; the design, implementation and the control of management metrics regarding medical accounts; and the participation in committees and multidisciplinary meetings where management and medical optimization plans get analyzed and proposed.

In their daily activities, the audits team must be alert to detect, in a timely manner, inconsistencies in the way that medical procedures are being executed. The result of succeeding in this task benefits the different actors that take part in the process and the greater institution itself, allowing it to ensure: The quality of the service provided; transparency in the relationship with insurance companies; and the accomplishment of the institutional mission of offering an integral service that is humane, safe and differentiated.

The personal and professional values of the audit’s team members of our clinic exist in context with our institutional values of honesty, respect and responsibility, that are fundamental pillars of how we present ourselves to the patients and insurance companies.

The internal audit’s office in our El Tesoro Center is located on the first floor, right beside the sample taking of the Reference Laboratory and behind the auditorium. In our Downtown Center, it is located on the eighth floor.