Medical billing audit
A medical billing audit is a retrospective review of a practice’s coding, claims, and AR to identify where revenue is being lost and what it would take to recover it.
Follows credit balances and refunds. Feeds into reporting and analytics.
Where practices lose money here
Losses hide across multiple small issues
No single denial or underpayment looks alarming on its own. The audit exists because the pattern across hundreds of claims is where the real dollar figure lives.
Practices do not know their real numbers
Without an outside review, a practice is usually working from a general sense of "billing feels slow" rather than a specific figure on denial rate, days in AR, or underpayment exposure.
How we handle it
Pull a representative sample of recent claims, sized to the practice’s volume, sufficient to identify real patterns rather than isolated incidents.
Review coding accuracy against documentation, checking for both under-coding and compliance risk from over-coding.
Assess whether documentation actually supports the E/M levels being billed.
Analyze denial patterns by category, payer, and root cause across the sample period.
Compare posted payments against contracted fee schedules to quantify underpayment exposure.
Review AR aging health and charge lag as indicators of process speed, and flag any compliance risk found along the way.
What you receive
Concrete output for this step, delivered on a set schedule rather than on request.
- A written findings report covering coding accuracy, denial patterns, underpayment exposure, AR aging health, charge lag, and compliance risk.
- A quantified recovery opportunity figure, in dollars, based on the sample findings.
- A turnaround agreed with you before the audit starts, set by the size of the sample.
Where this sits in the cycle
The audit looks backward across the entire cycle at once, rather than sitting at one point in it. It is usually the first engagement with a new practice and the basis for prioritizing where to focus first.
Questions about this step
Is the first audit really free?
Yes. The first billing audit is provided at no cost, with no obligation to engage further based on the findings.
What sample size do you review?
The sample is sized to the practice’s monthly claim volume, large enough to surface real patterns rather than one-off issues. We confirm the exact scope before starting.
What do we actually get at the end?
A written report with specific findings by category and a quantified dollar figure for the recovery opportunity identified, not a general summary.
How long does it take?
We agree the turnaround with you before starting, based on how large a sample we are reviewing. You will have a date in writing before any work begins.
Want us to review how this is handled in your practice right now?
The free billing audit looks at medical billing audit alongside the rest of the cycle, and comes back with specific findings.