99%+
Audit Accuracy
24 Hr
Turnaround
100%
HIPAA Compliant
99%+ Audit Accuracy
24 Hr Turnaround
100% HIPAA Compliant
What Is a Medical Billing Audit?
Our audits go beyond surface-level checks. We provide actionable insights that help practices improve revenue cycle performance, strengthen payer compliance, and reduce future billing risks.
Who Needs a Medical Billing Audit?
Small practices
Small teams often struggle with limited billing bandwidth, causing small errors to turn into repeated denials and missed follow-ups.
Large / Group Practices
High claim volume can hide significant losses when the same coding or workflow issues repeat across hundreds of claims.
Multi-Specialty Clinics
Different specialties follow different coding and payer rules, which often leads to inconsistent billing and frequent denials across departments.
Single-Specialty Practices
Specialty-specific payer requirements, modifier use, and documentation gaps can trigger recurring denials and payment inconsistencies.
Multi-Location Practices
Different workflows across locations often result in uneven claim quality, eligibility errors, and inconsistent collections.
Growing Practices
Growth, staff turnover, or EHR changes often disrupt billing workflows, leading to unexpected denials, delayed payments, and reporting gaps.
What Is Audited in a Medical Billing Audit
During a medical billing audit, we review:
- Claims and claim submissions to verify accuracy and clean claim standards
- Payments and EOBs/ERAs to identify underpayments and payment variances
- Adjustments and write-offs to ensure they are valid and properly applied
- Medical coding and modifiers to confirm compliance and reimbursement accuracy
- Denials and rejections to uncover recurring trends and root causes
- Charge capture processes to detect missed or delayed charges
- Audit summary with key findings
- List of revenue leakage opportunities
- Root-cause report explaining why issues occur
- Action plan to fix issues and prevent repeat errors
Internal Audit vs External Audit
- Internal billing audits are performed by in-house teams and typically focus on routine checks and compliance monitoring. While helpful, internal audits may miss systemic issues due to familiarity with existing workflows.
- External medical billing audits provide an independent review of claims, payments, and processes. An external audit often uncovers hidden issues such as payer underpayments, incorrect contractual adjustments, and workflow inefficiencies that internal teams may overlook.
Pre-Bill vs Post-Bill Audit
- Pre-bill audits review charges, coding, and documentation before claims are submitted. These audits help prevent denials, reduce rework, and improve clean claim rates.
- Post-bill audits analyze submitted and paid claims to identify underpayments, improper adjustments, and recovery opportunities. Post-bill audits are critical for revenue recovery and long-term process.
Why Medical Billing Audits
Are Essential to Financial Health
Common Revenue Leaks We Identify
Our Medical Billing Audit Process
Our audit process is structured, transparent, and efficient, designed to uncover billing issues, identify revenue opportunities, and improve long-term financial performance.
Claim & Payment Analysis
Claims and payment data are analyzed to detect discrepancies and variances.
Underpayment Identification
Underpaid and incorrectly reimbursed claims are identified.
Root Cause Analysis
We determine the root causes behind payment issues and recurring errors.
Recovery & Correction Plan
A targeted recovery and correction strategy is created to regain lost revenue.
Reporting & Recommendations
Detailed reporting and actionable recommendations are delivered.
Types of Medical Billing Audits We Offer
Pre-Bill Audits
Review coding, modifiers, documentation, and charge accuracy before claims go out to reduce denials and rework.
Post-Bill Audits
Analyze submitted and paid claims to identify underpayments, incorrect adjustments, and recovery opportunities.
Denial Audits
Identify top denial reasons and trends across payers to reduce repeat denials through root-cause fixes.
Underpayment Audits
Compare paid amounts vs expected/contracted rates to detect payer underpayments and reimbursement variances.
A/R Audits
Review aging A/R, follow-up workflows, and payer response patterns to improve collections and reduce days in A/R.
Coding Audits
Evaluate coding and modifier usage for accuracy and compliance to improve reimbursement and reduce audit risk.
Frequently Asked Questions
What does a medical billing audit include?
A medical billing audit includes a detailed review of claims, payments, adjustments, and denials to identify where revenue is being lost. The audit evaluates coding and modifier accuracy, payer reimbursements, denial trends, write-offs, and A/R follow-up workflows. The goal is to highlight errors, inefficiencies, and compliance risks and provide clear recommendations for improvement.
What revenue leaks can an audit uncover?
An audit can uncover underpayments from payers, incorrect contractual adjustments, missed or unbilled charges, recurring denial patterns, documentation and coding gaps, and aging A/R that isn’t being followed up properly. Many of these issues go unnoticed but can significantly impact cash flow over time.
How do I know if my practice needs a billing audit?
If your practice is experiencing rising denials, delayed payments, growing A/R, unexplained write-offs, or inconsistent reimbursements, a billing audit can help identify the root cause. Audits are also useful after system changes, staff turnover, or when revenue does not match patient volume.
Will you identify underpayments and payer issues?
Yes. The audit reviews paid claims, remittance data, and adjustment patterns to identify potential underpayments and payer inconsistencies. This helps highlight reimbursement trends, payer-specific issues, and opportunities to improve collections accuracy.
Can you audit denials and find root causes?
Yes. We analyze denials by payer, reason code, procedure, and workflow step to determine why claims are being denied. This includes identifying issues related to eligibility, authorization, coding, documentation, or submission processes, allowing practices to prevent repeat denials.
What data do you need and how long does it take?
Typically, we request claims data, denial reports, remittance (ERA/EOB) files, and an A/R aging report. Most medical billing audits take 1–3 weeks, depending on claim volume, data availability, and the scope of the review.
Request a Medical Billing Audit
or Get a Claim Audit Review
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