subject_line
Internal Control Survey
Practice name:
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Name of individual completing this survey:
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Email Address:
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Receipt & Posting of Payments
When mail is sent to the practice, where is it delivered?
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To the practice
To the owner's home
To a Post Office box
Who opens the business mail?
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Administrative Employees
Office Manager
Owner and/or Spouse
Do you use a check scanner to deposit checks directly at your front desk?
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Yes
No
If you use a check scanner, do you compare a daily report from your check scanner showing total scanned deposits against the total amount of actual checks that were to be scanned that day?
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Yes
No
N/A
Does your staff post payments from electronic insurance checks to patient balances when you receive payment notification from the insurance company, or when the payment is actually received in your bank account?
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Posted when notification received
Posted when funds are confirmed in bank account
Is a bank deposit slip for cash and check receipts prepared for each day your practice is open?
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Yes
No
We use a check scanner
How often is a bank deposit made?
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Daily
Every few days
Weekly
Every few weeks
Whenever it is convenient
Does your staff have the ability to delete procedures in your practice management software?
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Yes
No
Segregation of Duties
When payments are received from patients during checkout, who posts those patient payments to your practice management software?
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The SAME employee who accepted the payment
A DIFFERENT employee assigned to post payments
Who prepares your bank deposit slip for cash (and/or checks) received from patients?
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The SAME employee who accepted the payment
A DIFFERENT employee assigned to prepare the deposit
Who goes to the bank and makes the actual bank deposit?
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The SAME employee who prepared the deposit slip
A DIFFERENT employee assigned to make the actual deposit
An owner and/or spouse
Who at your practice has the authority to adjust or write-off patient balances in your practice management software?
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Owner, Spouse or Office Manager
Administrative Employee
Does a person with authority to approve adjustments & write-offs also post those same adjustments to your practice management software?
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Yes
No
Daily Office Close-Out Procedures
Do you review a deposit summary report from your practice management software for each day your practice is open as part of your daily "close-out" procedure?
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Yes
No
Do you check each day to verify that cash and checks posted as paid your software that day match the amount of cash and checks in your bank bag and ready for deposit (or the check total scanned in a check scanner)?
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Yes
No
Do you check each day that credit card payments posted as paid in your software that day match the amount of credit card payments processed as shown on your merchant services batch report?
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Yes
No
Do you check each day to verify that electronic insurance payments posted in your software as collected that day were actually posted as received in your online bank account register?
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Yes
No
Do you review write-offs and adjustments each day to determine if any were not authorized?
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Yes
No
Payment of Bills
Who are the authorized signers on your business bank account(s)
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Owner
Owner & Office Manager
Owner & Office Manage & Administrative Employees
How do you pay your practice bills? Check all that apply:
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Hand-written check
Check printed from QuickBooks
Online bill pay
Bill.com
Credit card
Who at the practice has access to your online business bank account(s)? Check all that apply:
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Owner and/or Spouse
Office Manager - View Only
Office Manager - Full Access
Administrative Employees - View Only
Administrative Employees - Full Access
Where do you store your blank company checks?
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Secure, locked location
Unlocked location
We don't have company checks
Do you have a signature stamp for company checks?
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Yes
No
Are any employees authorized to make purchases with a company credit/debit card independently without approval for each transaction?
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Yes
No
Do you review your credit card statement each month to verify that each staff purchase was authorized?
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Yes
No
No staff has access to a credit/debit card
Segregation of Duties
Who is primarily responsible for signing checks and/or approving online bill pay payments?
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Owner and/or spouse
Office manager
Administrative Employee
If a manager or administrative staff member prepares checks or online bill pay, does this same person have access to your practice QuickBooks file?
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Yes
No
N/A - Owner pays all bills
Once checks are signed, who controls them after that point and actually mails the checks?
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Owner and/or spouse
Office manager
Administrative Employees
We don't pay bills by check
Does an employee with authorization to use a company credit or debit card also have access to your practice QuickBooks file?
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Yes
No
Does an employee with access to your online bank accounts also have access to your practice QuickBooks file?
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Yes
No
Patient Refunds
How do you issue patient refunds? Check all that apply:
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Hand-written check
Check printed from QuickBooks
Online bill pay
Bill.com
Credit card refund
Does your merchant services provider allow you to restrict credit refunds or charge reversals so that your authorization is required prior to processing?
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Yes
No
Segregation of Duties
Who approves patient refunds prior to the refund payment being issued?
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Owner and/or Spouse
Office Manager
Designated staff member
Staff prepares - no approval
Who is responsible for posting those same refunds to your practice management software?
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The SAME employee who approves refund amounts
A DIFFERENT employee assigned to post refunds
Who prepares the actual refund check, online bill payment, or credit card refund for your patient refunds?
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The SAME employee who posted the refund in your software
A DIFFERENT employee assigned to prepare payments
Does an employee with approval to issue patient refund payments or credit card refunds also have access to your practice QuickBooks file?
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Yes
No
Payroll Management
Who has authorization to approve staff changes, such as salary changes, in your payroll processing system?
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Owner
Owner & Office Manager
Owner & Office Manager & Administrative Employee
If you award bonus payments, who is authorized to submit those amounts to your payroll processor?
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Owner
Owner & Office Manager
Owner & Office Manager &/or Administrative Employee
Do you regularly review your payroll reports at least once per month?
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Yes
No
Segregation of Duties
Who is primarily responsible for submitting payroll to your payroll processing service?
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Owner and/or Spouse
Office Manager
Administrative Employee
Does the same person who submits payroll information to your payroll provider also approve the payroll amounts?
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Yes
No
N/A - Owner handles all payroll
General Information
Is an equity partner or other stakeholder on site at each location a majority of the time?
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Yes
No
How many staff are stationed at the front desk or check-out area a majority of the time?
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1
2
More than 2
Do you have video surveillance of your check-out area?
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Yes
No
Have you ever been the victim of embezzlement?
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Yes
No
Please briefly describe what happened:
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What concerns do you have regarding your embezzlement risk given your first-hand knowledge of your practice operations?
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Please tell us what you think of this Internal Control Survey:
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Very helpful
Helpful
Somewhat helpful
Not very helpful
Not useful