Comprehensive Medical Billing Audit Services

Uncover revenue leakage and optimize your billing processes with our detailed medical billing audits.

Maximize Revenue Through Precision Auditing

Medical billing audits are not just about compliance—they're powerful tools for revenue optimization. Many practices unknowingly lose significant income through undetected billing errors, undercoding, or missed opportunities. Our comprehensive audit services meticulously examine your billing processes to identify both compliance risks and revenue enhancement opportunities.

With extensive experience across multiple specialties, our auditors understand the nuances of proper coding, documentation requirements, and payer-specific guidelines. We don't just identify problems—we provide actionable solutions that strengthen your revenue cycle while ensuring complete regulatory compliance.

92%

Error Detection Rate

18%

Average Revenue Increase

100%

Compliance Assurance

Common Billing Issues We Identify

Our audits routinely uncover these revenue-impacting issues

Undercoding Services

Providers often bill lower-level codes than documented, leaving legitimate revenue unclaimed.

Compliance Risks

Unbundling, incorrect modifier usage, or billing non-covered services that create audit exposure.

Documentation Gaps

Clinical notes that don't support the level of service billed, creating potential takebacks.

Missed Charges

Services performed but never billed, including injections, procedures, or time-based services.

Medical Necessity Issues

Services billed without adequate demonstration of medical necessity in documentation.

Time-Based Coding Errors

Inaccurate billing for time-based codes like critical care, psychotherapy, or prolonged services.

Our Medical Billing Audit Methodology

A thorough, multi-phase approach to comprehensive billing assessment

Pre-Audit Assessment

We begin with understanding your practice's unique billing patterns, payer mix, and specialty-specific coding challenges.

Chart Documentation Review

Our certified coders examine clinical documentation against billed services for accuracy and compliance.

Charge Capture Analysis

We analyze charge entry processes to identify missed billing opportunities and process inefficiencies.

Data Analytics & Pattern Identification

Advanced analytics uncover billing patterns, outliers, and trends that require corrective action.

Payer-Specific Compliance Review

We verify adherence to individual payer policies and local coverage determinations.

Actionable Reporting

Comprehensive reports with prioritized recommendations for both immediate and long-term improvements.

Documented Audit Results

Typical outcomes our clients experience after implementing audit recommendations

15-25%

Average revenue increase through identified opportunities

97%

Reduction in compliance risks and audit vulnerabilities

40%

Decrease in claim denials through process improvements

$3.8M+

Additional revenue identified for clients last year

Transparent Audit Pricing

Flexible options based on your practice's size and needs

How do we structure our billing audit services?

We offer customized audit approaches designed for your practice's specific requirements:

Sample-Based Audit

Statistical sampling of claims to identify patterns and estimate revenue impact

Ideal for: Initial assessment and compliance check

Comprehensive Audit

In-depth review of all billing processes and claims over a specific period

Ideal for: Practices preparing for potential audits

Ongoing Monitoring

Continuous audit process with regular reporting and improvement tracking

Ideal for: Sustained revenue optimization

Request Audit Proposal

Frequently Asked Questions

Common questions about our medical billing audit services

For most practices, we recommend reviewing 10-15 charts per provider or 5-10% of total claims, whichever is greater. This sample size provides statistical significance to identify patterns and extrapolate findings. For targeted issues, we might adjust the sample to focus on specific areas of concern.

The timeline varies based on practice size and audit scope, but most comprehensive audits take 2-4 weeks. This includes pre-audit planning, chart review, data analysis, and report preparation. We prioritize minimal disruption to your daily operations throughout the process.

Our team has extensive experience across all major specialties, including primary care, cardiology, orthopedics, general surgery, emergency medicine, psychiatry, and more. Each auditor maintains specialty-specific expertise to ensure accurate assessment of coding and documentation requirements unique to each field.

Not at all. We design our audit process to minimize disruption. Most information gathering occurs electronically, and we schedule any necessary staff interviews at convenient times. Our team works efficiently behind the scenes, with most practices reporting no noticeable impact on daily workflow.

We approach compliance issues with discretion and provide prioritized recommendations for corrective action. This may include voluntary self-disclosure protocols, refund processes, or compliance plan enhancements. Our focus is on education and prevention, not punishment, ensuring your practice moves forward with stronger, more compliant billing practices.

Ready to Optimize Your Billing Performance?

Discover how our comprehensive medical billing audit can increase your revenue and reduce compliance risks.

Start Your Audit Today