Even top-performing practices lose thousands yearly from coding errors, missed charges, and compliance gaps. A medical billing audit protects your revenue, verifies accurate claims, and stabilizes cash flow. Our medical billing audit services, conducted by auditing experts, uncover revenue leakage, cut compliance risks, and sharpen coding accuracy for hospitals, physicians, and healthcare providers across the USA by providing comprehensive auditing services that ensure accuracy and identify errors in medical billing and coding.
Every day you delay an audit, more revenue slips away. Even minor billing errors can cause significant financial setbacks. A single incorrect CPT code, missed modifier, or non-compliant claim can cost lost reimbursements.
Audits do more than detect mistakes; they help practices stay aligned with OIG, CMS, and payer requirements. Billing compliance is essential for adhering to regulatory requirements and streamlining workflows, which helps maximize revenue and ensure proper claim processing. With evolving healthcare regulations, a proactive audit shields your practice from denials, recoupments, and costly penalties. It is important to note that self auditing is not officially recognized by the federal government, specifically CMS, making it crucial to understand and follow federal guidelines to improve your medical billing practices.
If you’re searching for the best medical billing audit company, our proven track record speaks for itself. We combine coding expertise, compliance knowledge, and AI-driven tools, backed by deep industry expertise in healthcare billing audits and FQHC compliance reviews, to deliver audits that strengthen financial performance.
Our medical billing audit solutions cover every detail of your revenue cycle so you get paid on time and with full compliance. All audits are conducted in accordance with industry standards to ensure accurate reimbursement and long-term financial health. We provide customized services for hospitals, physician practices, and clinics.
Medical Coding Audit
Medical Billing Audit
We audit Medicaid, Medicare, commercial, and self-pay claims including Medicaid services to detect duplicate charges, missed modifiers, underpayments, and recover lost practice revenue. Our process includes reviewing for missing documentation to ensure accuracy, prevent claim denials, and support proper claim submission to the insurance company for timely reimbursement.
Clinical Audits
Collection Aging Audit
Revenue Cycle Management Audit
Payer-Specific Audit
Compliance Audit in Medical Billing
Ensure your practice meets HIPAA, OIG, and CMS standards, reducing compliance risks while keeping your revenue cycle audit-ready. We help healthcare providers improve reimbursements by identifying denial root causes and strengthening billing accuracy.
Clinical Documentation Improvement (CDI)
Government & Payer Mandated Audit
Our experts analyze denial trends, correct issues, and resubmit clean claims quickly within 24 hours without any disruptions in your cash flow.
Switching between systems wastes time. We integrate directly with your EHR and practice management software, creating a seamless workflow.
We handle ERAs and EOBs with accuracy, posting payments against claims and reconciling discrepancies. No payment goes unnoticed at our end.
Every provider faces different risks. That’s why we deliver multiple billing audit types, including:
Conduct pre-bill audits to prevent denials before submission.
Post-bill audits to recover missed revenue.
Objective claim accuracy checks.
Full-scale external medical billing audit, involving an external auditor to provide independent assessments for compliance, accuracy, and revenue security.
A dedicated project manager oversees the audit process and supports successful implementation and training.
Every provider faces different risks. That’s why we deliver multiple billing audit types, including: Reviewing the entire billing cycle helps verify regulatory compliance and identify billing errors through structured audit processes.
Reduce claim denials and accelerate cash flow for your practice.
Ensure alignment with OIG, CMS, and HIPAA standards, minimizing regulatory risk.
Receive a Corrective Action Plan (CAP).
Reduce claim denials and accelerate cash flow for your practice.
Our billing specialists manage audits while your team focuses on patient care.
A single audit can recover tens of thousands in lost revenue without adding new staff or increasing patient volume.
We gather and review your claims, coding records, and payer policies to fully understand your revenue cycle and identify potential risks before they become problems.
We conduct targeted and random audits across claims to find errors, missed charges, and areas of improvement for maximum revenue recovery.
Our team reviews ICD-10, CPT, and HCPCS codes, making sure everything aligns with payer rules and federal guidelines. This way, you can reduce denials, avoid penalties, and bill with confidence.
Deliver a thorough report detailing claim accuracy, coding discrepancies, compliance findings, and actionable insights to strengthen your revenue cycle.
Provide training, workflow fixes, and step-by-step guidance to correct identified issues and prevent future coding and billing errors.
Reassess your claims and processes after implementation to confirm sustained compliance, refined billing, and improved financial performance.
Worried about audit costs?
Most audits pay for themselves many times over. By identifying underpayments, reducing denials, and improving compliance, practices see measurable ROI within months.
Our Satisfied Clients
Discover how physician groups thrive with us.
Medical billing audits are the financial backbone of your healthcare practice, uncovering and correcting the revenue-draining errors that can choke your cash flow and expose you to compliance risks. We believe partnering with expert billing audit services gives you a competitive edge one that turns billing challenges into financial health. We’ve identified the most common billing pitfalls and how to get rid of them:
Coding errors are the #1 threat to your revenue. When outdated or incorrect ICD-10, CPT or HCPCS codes get into your claims, denied payments follow. Our medical coding audits, performed by certified coders, ensure every code matches the clinical reality of services provided. We consider coding precision non-negotiable a 99%+ accuracy rate means more cash flow and less administrative burden.
Submitting the same claim creates a paper trail that payers scrutinize intensely. We know duplicate billing often means systemic workflow breakdowns not isolated errors. Our billing audits are early warning systems, identifying duplicate patterns before payers investigate and freeze your revenue for months.
Claims without robust medical necessity documentation get rejected at a 15%+ industry wide. We view medical necessity reviews as detective work, analyzing clinical records to make sure every billed service has solid evidence. Our audits bridge the gap between clinical care and financial documentation, creating an unassailable foundation for your claims.
Simple process failures wrong patient demographics, missing documentation, incomplete forms create denial patterns that can drop your clean claim rate below acceptable levels. We treat billing process audits as system diagnostics, identifying where information breaks down and implementing controls to prevent future revenue leakage.
Healthcare is a regulatory maze where HIPAA violations and federal guideline breaches can cost you big time. We position our medical billing audits as your compliance shield, conducting proactive risk assessments to identify vulnerabilities before regulators do. Our approach turns compliance from a burden into a competitive advantage.
High denial rates mean deeper problems in your revenue cycle. We analyze denied claims as data points in a larger picture, doing root cause analysis to find systemic weaknesses. Our approach turns denial management into strategic prevention, reducing denial rates to industry best practices.
We recommend systematic audit cycles as preventive medicine for your revenue cycle, identifying and correcting errors before they become bigger financial problems.
Our integrated approach combines revenue cycle management with billing audit services, eliminating error-prone manual processes.
We provide ongoing education to keep your staff up to date with changing best practices and regulatory requirements, turning knowledge gaps into competitive advantages.
Our proactive risk management protocols include compliance monitoring and documentation reviews to prevent costly errors and support long-term financial stability.
We help you navigate HIPAA, OIG and CMS requirements with confidence, positioning compliance as a competitive asset not a regulatory burden.
We believe a good billing audit partnership turns revenue cycle management into a competitive advantage. When you work with our expert auditors and certified coders, you get comprehensive solutions for immediate financial success and long-term compliance. We speak your language denial management to compliance protocols and we’re here to help you get your revenue and peace of mind back.
Frequently Asked Questions
A modern medical billing audit checklist should cover:
With top-rated medical billing audit services, we help providers eliminate revenue leaks, reduce compliance risks, and stay ahead of payer scrutiny. If your practice is ready to increase financial health and protect reimbursements, now’s the time to act.
