Medical Billing Audit
An independent review of your claims, coding, denials and collections that shows exactly where revenue leaks — and what to fix first.
Most practices sense their billing is leaking but cannot point to where. A medical billing audit replaces the feeling with evidence: a structured review of your claims history, coding patterns, denial profile and collections performance, ending in a prioritized list of what to fix and what each fix is worth in process terms. Elite Bill Care performs billing audits for practices evaluating their in-house billing, their current billing company — or us.
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What the audit examines
- Denial profile — denial rate and categories by payer and reason code, benchmarked against your own claim volume; the top denial causes traced to their originating step (see denial management).
- Coding patterns — a sample review of E/M levels and procedure coding against documentation, looking for both undercoding (revenue left behind) and overcoding (audit risk) — see coding support.
- AR health — aging buckets, days in AR, and how much old AR is realistically collectible vs. written off silently (see AR management).
- Front-end accuracy — eligibility, authorization and demographics error rates at the steps where denials are born.
- Payer performance — payments compared to contracted expectations, with underpayment patterns identified from remittances.
- Process review — charge lag, submission lag, posting and follow-up discipline, and the reporting you currently receive (see reporting and analytics).
What you receive
A written report in plain language: findings, the evidence behind each one, and a fix sequence ordered by impact and effort. If the audit finds your billing is healthy, the report says so — an audit that always recommends the auditor is a sales document, not an audit. Where fixes are needed, the report maps each to the service that addresses it, whether you implement internally or through our outsourcing.
Frequently asked questions
What do you need from us to run an audit?
Access to recent claims, denial and AR reports from your system (typically the last 6–12 months), and a sample of remittances. Read-only reporting access is sufficient — an audit never touches live claims.
How is this different from a free consultation?
A consultation is a conversation about your situation. An audit is an evidence-based review of your actual billing data with a written findings report you keep either way.
Will an audit disrupt our current billing?
No. The audit is read-only and runs alongside your current operation; nothing about your claims flow changes unless you later decide to act on the findings.