Free Medical Billing Audit

What the free medical billing audit reviews

Our free medical billing audit shows where your practice is losing time or revenue, before you commit to anything. The free billing audit is a focused medical billing assessment carried out by certified billing and coding professionals, using reports from your own practice management system. You can also run our quick billing stress test first for a rough read on where you stand.

It works as a short revenue cycle assessment, or RCM audit: we follow the money from registration to the final payment and note where it stalls. Together the checks below give a practical practice revenue analysis, not a sales pitch.

Denials and rejections

A denial rate analysis groups denied and rejected claims by reason code, payer, provider and service. Repeat causes usually point to one step, such as registration, eligibility, authorization or a missing modifier, and that step is where the fix belongs. Our denial management page explains how those causes are worked once found.

Coding accuracy

We spot-check a sample of CPT, ICD-10-CM and HCPCS codes, E/M levels and modifiers against the note. For Medicare claims we also look for pairs of codes that conflict with the CMS National Correct Coding Initiative (NCCI) procedure-to-procedure edits. Patterns matter more than single errors: a provider billing nearly every visit at one level may be under-coding as easily as over-coding.

Charge capture

A charge capture audit compares what was scheduled and documented with what was billed. It finds add-on codes, injections, supplies or separately payable services that never reached a claim, and charges entered too late to file.

Payer underpayments

We compare actual payments with your fee schedule and any payer contracts or fee schedules you have on file. Payments below the contracted rate are often posted as routine contractual adjustments and never questioned. Confirmed variances can be handed to underpayment recovery.

A/R over 90 days

An AR analysis by payer and aging bucket shows where follow-up has stopped. Balances older than 90 days get extra attention, especially claims close to a payer's timely filing limit, because those are the ones that can still be saved if someone acts now.

We also check the front end of the cycle, because many denials start there: missed insurance checks, missing authorizations and providers who are not yet enrolled with a payer. Each item reviewed is listed below.

Who the audit is for

The audit is designed for physician practices and outpatient providers who bill professional claims, whether billing is handled in-house or by another company. It is most useful when something has changed and you are not sure why:

• Collections have dropped while patient volume has not.
• Denials or rejections are rising, or the same ones keep coming back.
• AR is growing and older balances are not being worked.
• New payer contracts, providers or locations have been added.
• You are considering a new billing partner and want an independent view first.

The HHS Office of Inspector General's compliance program guidance for individual and small group physician practices describes periodic auditing and monitoring as part of an effective compliance program. A billing review is a practical way to start that habit and to keep healthcare billing compliance on the agenda, not only when a payer letter arrives.

What you get: a sample of the findings report

• Written findings that describe what we found, where it happens and how often in the sample reviewed.
• Recommended fixes for each finding, in order of priority, whether or not you work with Fastora.
• A walkthrough call with a billing specialist to go through the findings, answer questions and discuss which fixes your team can make on its own.

Each finding in the report follows the same format, so your team can act on it without a translator:

The findings are yours to keep and use with your current team or biller. Our article on revenue leakage in medical practices explains the most common leaks in more depth.

How long the audit takes

The timeline depends mostly on how quickly the reports can be exported and on the size of the practice: the number of providers, payers and locations, and the date range reviewed. A solo practice with one system and a handful of payers needs less review than a multi-location group.

1. Request your free billing assessment using the form. We reply within one business day.
2. Short intake call to understand your specialty, payers, system and current concerns.
3. Send the reports listed below through the channel we agree.
4. Review by our billing and coding professionals.
5. Findings and walkthrough call with written recommendations.

We agree a date for the walkthrough call once we have seen the reports, rather than quoting a standard turnaround. Most of the work is on our side; your team's part is the intake call, the exports and the call itself.

What we need from you

We work from read-only reports your practice management system already produces:

• AR aging report by payer
• Denial or rejection reports
• Remittance reports (ERA or EOB summaries)
• Your fee schedule and any payer fee schedules or contracts you have on file
• A list of providers and the payers you bill

These reports are usually available in a few clicks from most practice management systems, and your office manager or current biller can export them. The request form does not collect patient information, so please do not include patient names, dates of birth or other health information in it.

Protected health information

Summary reports are enough for most of the audit. Coding and charge capture spot-checks need a small sample of encounter notes, which we review only after a Business Associate Agreement is signed. That is the HIPAA compliant billing approach any outside reviewer should follow, under workflows aligned with HIPAA and HITECH, with encryption, strict access controls and regular internal audits.

Free audit or full medical billing audit services

The free review is the same starting point we use when onboarding a new practice. Some practices want to go further, and our medical billing audit services can extend it with a larger claim sample, a documentation review against billed services and a follow-up check after fixes are in place.

A billing audit is broader than a coding audit. A coding audit asks whether documentation supports the codes billed; a billing audit also looks at eligibility and authorization gaps, claim edits, payer responses, posting accuracy, contract payments and follow-up. Focused coding audits for specific providers are part of our medical coding services.

Practices looking for medical billing audit services usually want the same checks listed here applied to a defined sample of claims, with written findings they can act on whether or not they change billing companies.

No obligation, and no promises of savings

The audit is free and there is no obligation to switch billers or sign anything. Many practices use the findings to fix problems with their current team, and that is a perfectly good outcome. We will not promise a savings figure before we have seen your data, and the findings report sticks to what the reports show.

If you do decide to outsource, you can read how outsourced billing works, see our full revenue cycle management service or review our pricing models.