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Protect your practice from costly billing errors, compliance violations, and revenue leakage with professional medical billing audit services. Our certified auditors identify coding inaccuracies, documentation deficiencies, and compliance gaps, recovering an average of $47,000 in missed revenue per audit while reducing denial rates by 60%.
Healthcare billing audits aren’t optional; they’re essential protection against claim denials, government investigations, and financial losses. One coding error can trigger payer audits, resulting in thousands in repayment demands. Our proactive audit services identify and correct issues before they become expensive problems, ensuring your practice receives every dollar earned while maintaining complete regulatory compliance.
Don’t risk your practice’s financial health and reputation. Partner with experienced medical billing auditors who thoroughly examine coding accuracy, documentation completeness, and compliance adherence, delivering actionable recommendations that strengthen your revenue cycle and protect against penalties.
Medical billing and coding audits are systematic examinations ensuring your billing claims, coding practices, and documentation meet payer requirements and regulatory standards. Certified professional auditors review patient charts, billing records, and claim submissions, verifying correct code assignment matching diagnoses and services provided.
Like routine physical examinations, detecting health issues early is crucial. Billing audits diagnose revenue cycle problems, allowing corrective action before they escalate into denied claims, compliance violations, or financial penalties.
Healthcare billing audits reveal critical issues, including improper coding (upcoding/undercoding), incomplete clinical documentation, unbilled services and missed charges, non-compliance with Medicare/Medicaid guidelines, incorrect modifier usage, and gaps in medical necessity documentation.
Regular comprehensive audits strengthen revenue cycles by correcting errors proactively, ensuring accurate code selection, maintaining complete documentation, optimizing legitimate reimbursement, ensuring compliance with payer policies, and protecting overall financial health while preventing government scrutiny.
Professional Medical Billing Audit Services That Protect Your Practice
Medical billing and coding involve complex regulations, creating numerous opportunities for costly errors requiring vigilant oversight. Our medical billing audit services provide this essential monitoring, serving as your financial safety net, preserving the integrity of your entire claims process.
Our Comprehensive Approach: Experienced certified auditors meticulously examine documentation quality, coding accuracy, and claim submissions, uncovering inaccuracies while identifying opportunities for revenue cycle improvement. Our detailed findings guide healthcare organizations toward error-free coding and complete revenue capture.
Compliance Protection: Equally important, our audit program prevents billing compliance violations and fraud that trigger fines, penalties, exclusions from federal programs, and damaged professional reputation. Our audit services form a fundamental pillar upholding clinical excellence, financial performance, and regulatory compliance.
Comprehensive Medical Billing & Coding Audit Services
Complete Coding Accuracy Review: Comprehensive evaluation of all medical record types—including inpatient hospital stays, outpatient visits, professional fee services, surgery, and diagnostics—ensuring proper code assignment.
Multi-Specialty Expertise: Certified coders examining ICD-10-CM, CPT, HCPCS, E/M level selection, and bundling compliance to ensure accuracy regardless of practice specialty.
Claims Submission Review: Thorough examination of Medicare, Medicaid, commercial, and workers' compensation submissions to identify billing errors and patient responsibility miscalculations.
Revenue Cycle Analysis: Assessment of charge capture processes, payment posting accuracy, and denial management to identify systemic issues causing revenue leakage.
Regulatory Audit Preparation: Expert assistance for Medicare TPE, RAC reviews, OIG investigations, and DMEPOS supplier audits with comprehensive documentation organization.
Appeal Support: Professional representation during audit processes, negotiation with audit contractors, and clinical record submission to minimize repayment demands.
Quality & Safety Assessment: Evaluation of care quality, patient safety protocols, and satisfaction of core measure requirements supporting quality reporting and reimbursement.
CDI Program Development: Clinical Documentation Improvement establishment including physician education and query processes to accurately reflect severity of illness.
Accounts Receivable Recovery: Systematic review of aged AR to identify collection opportunities and implementation of recovery strategies for claims aging beyond 90, 120, and 180 days.
Denial Recovery Services: Analysis of denied claims, correcting coding errors, and pursuing underpayments from payers to recover previously lost revenue.
Medicare Compliance Focus: Specialized audits ensuring services are medically necessary and compliant with Medicare coverage policies (LCDs) to protect from overpayment demands.
RAC Readiness Assessment: Proactive evaluation of Medicare billing practices to identify high-risk areas targeted by Recovery Audit Contractors.
Are you uncertain about your medical record quality, coding accuracy, or compliance status? Our comprehensive audit services provide complete transparency, revealing exactly where your billing practices stand and what improvements are needed.
Schedule Your Free Audit Assessment TodayYour Billing Challenges, Our Audit Expertise
Inaccurate billing and coding practices cost medical practices significantly. Our medical billing audit services identify precisely what's broken in your workflows, analyzing people, processes, and technology to deliver specific, actionable recommendations.
Billing errors severely impact financial stability, cash flow, profitability, and long-term sustainability threatening practice viability through consistent revenue loss and operational inefficiency.
Comprehensive billing audits thoroughly examine each claim verifying correctness, identifying systemic error patterns, and implementing validation protocols securing maximum appropriate reimbursement.
Coding inaccuracies lead to claim denials, revenue loss, improper charges (over/under), patient dissatisfaction, compliance violations, and potential legal actions creating financial and reputational damage.
Advanced natural language processing and machine learning analysis of medical records catching coding mistakes before submission, optimizing accuracy, and preventing downstream denials.
Compliance violations result in severe penalties including monetary fines, government audits, investigations, civil/criminal lawsuits, Medicare sanctions, and exclusion from federal healthcare programs.
Robust billing analytics identifying trends, outliers, and compliance red flags in real-time enabling targeted audits eliminating risks before government scrutiny begins through proactive monitoring.
Reimbursement reductions force healthcare providers to reduce staffing, limit service offerings, close practice locations, restrict Medicare patient acceptance, or exit practice entirely.
Proprietary AI-powered audit systems analyzing claims data identifying missed revenue opportunities and ensuring complete revenue capture before reimbursement cuts impact bottom-line profitability.
Comprehensive Audit Methodologies for Complete Coverage
In-depth evaluation of internal processes, workflows, and documentation practices ensuring alignment with industry standards, payer requirements, and regulatory guidelines while identifying inefficiencies and improvement opportunities.
Detailed recommendations for operational improvements including staff training needs, workflow optimization, technology utilization, and best practice implementation elevating overall billing department performance.
Independent examination of claims and payments from Medicare, Medicaid, and commercial insurers identifying underpayments, resolving billing disputes, recovering incorrect denials, and pursuing aged receivables maximizing revenue recovery.
Verification that reimbursements align with contracted fee schedules, proper application of contractual adjustments, and identification of payer underpayment patterns enabling contract renegotiation or dispute resolution.
Evaluation of claims before payer submission ensuring accuracy, completeness, and compliance with coverage policies preventing denials, rejections, and payment delays through proactive error correction.
Continuous monitoring of claims as they're prepared identifying and correcting issues immediately before they enter the revenue cycle preventing rework costs and accelerating reimbursement timelines.
Examination of processed claims after payer adjudication identifying coding errors, documentation deficiencies, and reimbursement inaccuracies enabling corrective actions, denial appeals, and revenue cycle optimization.
Analysis of historical patterns revealing systemic issues, recurring error types, and training needs informing long-term improvements preventing future mistakes through targeted education.
Complete evaluation of entire medical practice operations examining all aspects including coding accuracy, billing processes, documentation quality, compliance status, revenue cycle efficiency, and financial performance.
Comprehensive action plan addressing identified issues with prioritized initiatives, implementation timelines, responsible parties, and measurable success metrics creating roadmap for sustained improvement.
Missing Revenue? Our Audits Recover Lost Income
Specialized audits systematically examine claims data and billing records uncovering improper payments, missed charges, undocumented services, and coding errors that have cost your practice thousands in lost revenue. Our recovery audits identify every dollar you've earned but not captured, then implement processes ensuring complete charge capture moving forward.
Start Your Free Revenue Recovery Audit TodayOur Medical Billing Audit Performance Statistics
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Precise Billing & Coding Compliance Framework
Principal audit objective involves thoroughly investigating medical charts ensuring diagnosis codes, procedure codes, and E/M levels accurately mirror documented conditions, performed procedures, and visit complexity.
Correct coding proves vital for appropriate reimbursement. Our audits identify upcoding violations, undercoding revenue loss, and modifier errors recommending specific remedial actions.
With our assistance, providers confidently know their coding satisfies payer standards and complies with regulatory requirements.
Essential audit element validates all rendered services and utilized supplies are captured in billing at appropriate rates preventing missed charge revenue loss.
Auditors diligently compare clinical documentation to itemized billing statements identifying missed charges and unbilled procedures.
Recommendations for charge capture workflow improvements and CDM optimization maximize reimbursement by closing legitimate charge gaps.
Thorough documentation review evaluates whether medical records provide clear, consistent, complete documentation supporting coded claims satisfying payer scrutiny.
Comprehensive documentation justifies charges and supports medical necessity. Our team identifies issues like missing signatures or insufficient detail.
Guidance provided strengthens documentation practices through physician education and EHR optimization improving claim defense capabilities.
Examination of proper insurance contract application, fee schedule accuracy, and identification of payer underpayment patterns ensuring contracted rates are honored.
Verification of accurate data entry into billing systems, proper fee schedule loading, and elimination of data entry errors that sabotage reimbursement.
Recommendations for billing system improvements and automated validation rules enhancing accuracy and preventing revenue loss.
Comprehensive Post-Audit Reports Delivered to Your Inbox
We provide in-depth reporting offering complete visibility into coding and billing operations with specific, actionable recommendations. Request any of these essential audit reports:
Comprehensive analysis of charge capture processes identifying front-end issues leading to missed charges and revenue loss with quantification of financial impact.
Detailed improvement recommendations including workflow modifications, technology enhancements, staff training needs, and quality control implementation ensuring complete charge capture.
Statistical analysis of coding accuracy rates across specialties, payers, and service types with sample chart reviews identifying error patterns and improvement opportunities.
Quantification of revenue impact from coding errors including undercoding revenue loss, overcoding compliance risk, and optimal coding opportunities with specific corrective education recommendations.
Compliance risk analysis helping prioritize audit focus areas, high-risk coding patterns, and targeted education needs addressing most critical issues first.
Comprehensive denial data analysis identifying leading denial reasons, denial rate trends by payer/service type, and patterns indicating systemic issues requiring correction.
Evaluation of denied claims determining which warrant appeals based on documentation support, payer error identification, and likelihood of overturn success.
Specific recommendations preventing future denials through improved documentation, authorization management, eligibility verification, and coding accuracy initiatives.
Comprehensive assessment gauging compliance risk levels across coding accuracy, billing documentation, Medicare regulations, HIPAA privacy/security, and state-specific requirements.
Quantified risk exposure measurement across multiple compliance domains with color-coded risk ratings (high/medium/low) enabling prioritized remediation focus.
Detailed action plan strengthening compliance program through policy development, staff education, monitoring protocols, and audit schedules reducing risk exposure systematically.
Comparison of your key performance indicators against industry averages, specialty-specific benchmarks, and best-in-class performers identifying improvement opportunities.
Examination of critical metrics including first-pass resolution rate, net collection rate, days in accounts receivable, clean claim rate, denial rate, and cost to collect.
Specific recommendations for metrics below benchmark with implementation strategies, expected improvement timelines, and return on investment projections.
Our Systematic Approach to Medical Billing Audits
Consultation understanding your practice specialty, size, concerns, and audit objectives determining audit scope, sample size, and focus areas.
Secure gathering of medical records, billing data, claim files, and relevant documentation with proper HIPAA-compliant handling and organization.
Certified auditors systematically examine sampled records evaluating coding accuracy, documentation completeness, medical necessity support, and compliance adherence.
Compilation of audit findings with statistical analysis, error rate calculations, financial impact assessment, and compliance risk evaluation.
Development of specific, prioritized recommendations with implementation guidance, responsible parties, timelines, and success metrics.
Post-implementation follow-up confirming corrective actions taken with re-audit validating improvement and sustained compliance.
Why Regular Billing Audits Are Essential
Identify and recover missed charges worth thousands monthly.
Correct issues before they cause claim denials.
Avoid penalties, fines, and program exclusions.
Identify vulnerabilities before government audits.
Strengthen medical records quality and defensibility.
Targeted training addressing specific weaknesses.
Streamline workflows eliminating inefficiencies.
Reduce disputes and audit triggers with clean claims.
Maintain financial health enabling long-term growth.
Total confidence in billing integrity and compliance.
Audit Services for Every Practice Type
Medical billing audits benefit practices of all sizes and specialties by ensuring financial integrity and regulatory compliance.
Crucial for surgery, cardiology, orthopedics, oncology, and pain management where coding complexity is high.
Essential for primary care, urgent care, and multi-location groups handling thousands of claims monthly.
Establish proper billing processes and documentation compliance from the start to prevent future liability.
Scale your operations and revenue without losing accuracy or falling behind on current coding guidelines.
Expert support to respond effectively to payer or government reviews and minimize potential penalties.
Perform necessary due diligence before transactions to identify hidden liabilities or revenue opportunities.
Validate billing accuracy after personnel changes to ensure continuity and prevent revenue leakage.
Verify proper EHR/PM system utilization and data entry integrity following software migrations or updates.
Flexible Audit Solutions for Every Need
Don't wait for denied claims, payer audits, or compliance investigations to reveal billing problems. Proactive medical billing audits identify and correct issues before they become expensive crises, protecting your revenue and reputation. Our certified auditors bring decades of experience across all specialties to help your practice thrive.
Schedule Free Audit ConsultationJoin 1,500+ Practices Protecting Revenue Through Regular Audits
Healthcare Billing Services is a full-service medical billing company, managing everything from coding and claims to payment and follow-up. Our expertise ensures accurate, efficient billing for practices of any size or specialty, so you can focus entirely on patient care.