Better you find it than the payer does.
Doctor, a payer audit starts with a records request and ends with a repayment demand covering claims you were paid for years ago. A retrospective audit of your own asks the same questions first, while the answers are still yours to fix.
Find the gap between the record and the result
A focused audit follows a sample from documentation to charge, claim and payment. Findings are organized by the underlying issue so your team can act on them, rather than receive another unexplained spreadsheet.
Define the sample
Trace the evidence
Prioritize corrections
One habit, applied for years
A modifier used the same wrong way since 2019 is not one error. It is every claim that carried it, and the payer will extrapolate from a sample rather than read them all.
You are billing below your own average
Undercoding does not create audit risk but it does create loss. It shows up only when somebody compares your distribution against your documentation, which nothing in your billing system does.
The request arrives with a deadline
A records request comes with a return date. Assembling charts and reading them for the first time under that clock is the worst possible moment to discover a pattern.
Chart level review, with dollar figures attached
Here is what the work looks like, from the first review to the next action.
A defined task.
A documented action.
A visible next step.
Agree the sample and the scope
We fix which providers, which date range and how many charts before anything is read, so the findings represent your practice rather than a convenient slice of it.
Read the chart against the claim
Each selected chart is read against what was billed and against current guidelines. Not a spreadsheet review, an actual reading of the documentation.
Flag both directions
Overcoding is the audit risk and undercoding is the revenue loss. A report that only shows one of the two is doing half the job.
Rank findings by exposure
Every finding gets a frequency and a dollar figure, so you can tell a systemic pattern apart from a one off and spend your attention accordingly.
Hand over a remediation plan
Findings without a fix are just criticism. You get what to change, who needs to change it, and provider education on the items that came up repeatedly.
Included in a medical audit
Agree the scope with your practice, then keep the day-to-day work organized around it.
- Chart level review against current guidelines
- Agreed sample size and scope before work begins
- Undercoding and overcoding both flagged
- Modifier and medical necessity review
- Findings ranked by frequency and revenue impact
- Written remediation plan
- Provider education on recurring findings
- Re-review after remediation on request
Findings your team can work from
Each finding needs a supporting record, an explanation and a practical correction. Separating isolated exceptions from recurring patterns helps your team focus on the changes that matter.
A self audit and a payer audit ask the same questions
The only difference is which one lets you fix the answer.
| Situation | Payer audits you | You audit yourself first |
|---|---|---|
| A pattern is found | Extrapolated across the lookback period | Corrected going forward |
| Documentation is thin | Claim recouped | Provider education, before the next claim |
| You have been undercoding | Not mentioned, it is not their loss | Quantified and corrected |
| Timing | Their schedule, with a deadline | Yours |
| The outcome | A repayment demand | A remediation plan |
A few things to know before we start
The right scope starts with a clear conversation.
Ask it directly. You will get an answer from somebody who works accounts, not a sales script.
Monday to Friday, 8am to 5pm Central TimeIs the audit really free?
The initial practice audit is free, and it reviews your last 90 days of claims. A deeper chart level audit across a longer period is quoted separately, and we will tell you first whether the 90 day review suggests one is warranted.
What if you find something serious?
We tell you plainly, with the frequency and the exposure. What you do about a potential overpayment is a decision for you and your attorney, and we will say so rather than advise you on it.
Do you need our charts?
For a chart level audit, yes, for the agreed sample only. The 90 day review works from claims and remittance data.
Will you audit work another company did?
Yes, and that is a common reason practices call. The findings go to you, not to your previous biller.
Most practices do not buy one service in isolation. These are the ones that change the same numbers.
Start with the free 90 day audit
Tell us your specialty and the billing issue you want reviewed. We will agree the scope and arrange a secure way to share any records needed.