Business hours: 9:00 to 5:00 | Monday to Friday

Medical Billing Audit

An audit is a periodic assessment of your medical practice according to the current billing and documentation standards. The purpose behind performing a billing audit shows the depth it carries but a thorough approach for execution will produce actionable and better results. A comprehensive billing audit is the only way to navigate the Billing Errors and rectify documentation lags. There is no one-size-fits-all to perform the complete audit for different healthcare organizations but to get standardized results, each medical setup should generally consider certain steps while performing a medical billing audit.

How To Perform Medical Billing Audit With Maximum Precision?

An audit helps to pin out the billing mistakes and prevent them from occurring repetitively. It acts like a medicine to solve billing issues and stops them from affecting the overall health of your practice. The way an audit is performed says a lot about the validity of the results. The findings of an audit count for the growth of the medical practice to increase its productivity for higher revenue growth. The outcomes of a well-organized billing audit highlight the major reasons behind fraudulent claims, wrong billing, false coding, under-coding, up-coding, and documentation deficiencies. Physicians Revenue Group, Inc. has a team of great professionals who help you recognize and adjust the main deficits according to the latest healthcare standards.

Step 1 - Map out the scope and process

There is a reason behind every audit followed by particular scope on how to perform it. The process to perform an audit should cover all billing frontiers like patients’ documents, medical charts, submitted claims and claims denied with complete EOB. To maximize the scope of an audit one must not leave any useful information or resource that can help to effectively execute the billing audit. The purpose of the scope is to uncover the process of executing an audit and helps providers to gain precise outcomes and better results.

  1. The first thing to consider is the overall information provided by practitioners, patients, and billing staff to identify loopholes in the submitted information for greater relevancy.
  2. Hire a third-party audit team who works as an external consultant and conducts the review. Unlike other external auditors Physicians Revenue Group, Inc. has the subject matter expertise and ability to give unbiased commands for the betterment of your medical practice. 
  3. Plan out to find certain medical billing audit tactics. The right way to access medical charts and documents is to randomly select and analyze certain files to discover under-coding, over-coding, and fraudulent coding.

     4. Write down everything noticed during the process as a formal audit plan.

Step 2 - Assess the scene

It is important to assess the billing reports to find out the unforeseen billing and coding mistakes in the medical charts. While evaluating, also compare the past vs. recent pattern of filling documents to identify discrepancies.

  1. Run a comparative analysis between the physicians’ billing patterns with a standard pattern from the latest industry benchmarks issued by the insurance carrier.
  2. Run a report outlining the reimbursement process for your CPT codes. To ensure that each payer instantly provides payment approval, you can compare the results with the covenant terms.

Step 3 - Make adjustments

  1. Set an improvement goal, such as lowering the percentage of denied claims or raising revenue per patient, armed with the above-mentioned information.
  2. Get payers to pay their agreed rates accurately and on time by making a concerted effort to do so. Perform as many follow-ups as needed to create a strategy for late payment handling.
  3. Deal with any internal issues and educate your team and providers on strengthening the weak areas.

Step 4 - Repeat

  1. Make audits an ongoing practice. Carrying out an internal medical billing audit at least once a year is recommended if you handle medical billing in-house. Big practices may carry them out as frequently as once every three months.
  2. Create protocols for your medical billing business to facilitate auditing. Monitor net collections and run periodic reports.


With a Medical Billing Audit company like Physician Revenue Group, Inc., one can reduce the odds of inducing billing audits and improve the overall revenue cycle management. Only a proactive and experienced team with established practice, expert knowledge, and helpful billing audit tools can let you identify audit-inducing problems and manage claims.

Physicians Revenue Group, Inc. has enough experience to carry out billing and coding improvements efficiently. We know how to protect your healthcare facility from the potential hazards of wrong billing and delayed claims. Our experts help you to streamline your medical practices, improve revenue, and trim overhead costs. Based on your healthcare-specific needs, we also provide customized solutions, including medical billing services.



Recently Added

We Would Love to Assist You!

We treat your data confidentially and don’t share any information with a third party.