It’s no surprise that medical practices commonly struggle with internal controls. Because many physician practices are small operations with one or two doctors, they oftentimes are staffed with one person in charge of multiple tasks. The front desk person may also be the employee who checks in and checks out patients, posts payments, and handles billing. For these practices, naturally occurring internal controls are rarely in place. The good news is there are a few simple actions a physician practice can take that will make a big difference. For practices that need a more comprehensive evaluation of their control environment, internal audit services can help identify control gaps, assess financial and operational risks, and prioritize improvements.
VIDEO: 6 Internal Controls to Implement in Your Physician Practice
Internal Controls Every Physician Practice Should Implement
These six internal controls can help physician practices strengthen financial oversight, reduce the risk of fraud, and improve the accuracy and reliability of the revenue cycle.
1. Separate financial and accounting duties.
If your financial and accounting duties are intertwined, you are not alone, but these roles should be segregated. In other words, the person taking payment should not be the same person who gets the bank deposit ready or makes the bank deposit. Take the copayment and put it in the practice management system, and then have the posting person apply it to the payment. Separating the financial function from the accounting function is a simple step you can take along the internal control process.
Segregation of duties is also one of the foundational internal controls that prevent fraud across other industries. Dividing responsibility for authorizing transactions, recording activity, reconciling accounts, and accessing funds makes it more difficult for one person to both commit and conceal fraudulent activity.
2. Reconcile your bank deposits to your practice management system daily.
To prevent embezzlement, reconcile your bank account deposits with your practice management system totals each day. If your front desk clerks say they collected $50 in cash one day, make sure that $50 has been accounted for and posted into the practice management system for that day. Daily checks and balances will prevent larger problems in the long run.
3. Reconcile your bank account each month.
In addition to the daily reconciliation, as a best practice reconcile your bank accounts on a monthly basis. Monthly reconciliations are especially crucial when tracking electronic funds transfers (EFTs). For example, if an EFT comes in after bank deposits have been checked for the day, your billing team may miss posting it. An insurance payment that wasn’t caught initially can be rectified as long as you have a solid process in place. Clear communication among your team will allow you to later go back and post the payment, and the issue is solved before it becomes a problem.
Practices should also establish controls around outgoing electronic payments and changes to payment instructions. Effective wire fraud prevention can include independently verifying payment changes, limiting who can initiate or approve transfers, and requiring secondary authorization for higher-risk transactions.
4. Pay attention to petty cash.
One of the most common ways people steal from a practice is from petty cash, as there are few controls in place to prevent it. Many offices have petty cash housed at the front desk for incidental expenses, but receipts often go missing when employees spend the money. Even though the amounts may be small, they can add up over time, costing you more than you think. Put a system in place to account for your petty cash expenses, and make sure you know your employees who are responsible. Whether it’s through a background check or other internal control, it’s important to pay attention to those who are handling your money.
5. Run background checks.
Background checks are a good idea for all practices, but they are a must-have for practices that handle large sums of cash. At a minimum, make sure you run background checks for any employees who are designated to handle large amounts of money. For example, an ophthalmology practice that performs LASIK, cataract, or other cash-paying surgery will want to make sure employees can be bonded. Investing in a background check for the right employee will pay off in dividends.
6. Implement internal controls on your check signatures.
Another key question to ask in your practice is who is authorized to sign checks and approve payments. Avoid giving one individual unrestricted authority over the entire payment process. Establish clear authorization limits, maintain an approved signer list, and consider requiring a second approval for payments above a defined threshold. These controls make unauthorized disbursements more difficult and create additional opportunities to detect suspicious activity before funds leave the practice.
Strengthening Financial Oversight in Your Physician Practice
For many physician practices, limited staff and overlapping responsibilities can make internal controls difficult to maintain. Without clear processes in place, simple oversights can lead to revenue leakage or create opportunities for fraud. By implementing practical controls—such as separating financial duties, performing regular reconciliations, monitoring cash handling practices, and strengthening payment authorization—physician practices can improve financial oversight and protect the integrity of their revenue cycle.
Organizations that need a broader evaluation of financial risk and controls can also explore LBMC’s audit and assurance services. For practices specifically focused on evaluating control design, identifying process weaknesses, and strengthening risk management, LBMC’s internal audit services provide a more targeted path.
If your organization needs assistance improving revenue cycle processes or strengthening day-to-day financial operations, the LBMC Physician Business Solutions team can help identify risks and implement practical solutions that support stronger financial management.
Kathi Rennick is Director of LBMC Physician Business Solutions.
