Medical Practice Audit
A comprehensive Medical Practice Audit helps identify operational inefficiencies, revenue leakage, compliance vulnerabilities, and improvement opportunities across the entire revenue cycle.
By conducting a meticulous review of the front-end process, Coding, Charges, Payments & Outstanding AR, our audit delivers a clear, actionable roadmap designed to enhance financial performance, strengthen compliance, and significantly improve overall organizational efficiency.
What is a Medical Practice Audit?
A Medical Practice Audit is a detailed, systematic examination of a medical practice's clinical, financial, administrative, and compliance processes to ensure everything is accurate, efficient, and aligned with healthcare regulations and payer requirements. It helps the practice identify errors, inefficiencies, revenue leaks, and compliance risks across the entire Revenue Cycle Management workflow.
Purpose of a Medical Practice Audit
Coding & Documentation
CPT/HCPCS Accuracy
CBS audits all claims for CPT accuracy to ensure every service is coded correctly and billed appropriately to the insurance carriers. This reduces coding errors, prevents avoidable denials, and ensures the practice receives accurate and timely reimbursement for all services rendered.
ICD-10 Coding Correctness
CBS audits all ICD-10 diagnoses to ensure they are fully compatible with the CPT codes billed and meet the required medical necessity guidelines. This helps prevent claim denials, supports accurate reimbursement, and ensures compliance with payer policies.
Modifier Usage
CBS conducts a thorough audit of every claim to ensure modifiers are applied correctly and only when medically appropriate. We verify that modifiers are neither overused nor omitted, helping to prevent denials, maintain compliance with payer guidelines, and ensure each claim is billed accurately for proper reimbursement.
Provider Documentation Compliance
We audit provider documentation to ensure that the level of service billed on each claim is accurate and fully supported. This not only protects the practice from compliance risks but also significantly reduces the likelihood of audits or takebacks from insurance carriers.
E/M Level Validation
CBS performs a thorough audit of all E/M codes billed on claims to ensure the correct level is selected based on documentation. Accurate E/M coding prevents underbilling, which can lead to significant revenue loss for the practice, and ensures full reimbursement for the services provided.
Charges
Charges Vs. Appointments
CBS performs an audit of all scheduled appointments to ensure that charges are created and submitted for every encounter. This prevents missed or unbilled claims, eliminates gaps in billing, and helps streamline workflow while maximizing revenue for the practice.
Timely Submission of Charges
CBS also audits the lag between charge creation and claim submission to ensure timely processing. Any delay in submitting charges can lead to Timely Filing denials, resulting in preventable revenue loss for the practice.
Fee Schedules
CBS audits the practice's fee schedule to ensure that all claims are billed with the correct fees for both insurance carriers and patients. Billing with a lower fee schedule can result in underpayments, while using a higher-than-approved fee schedule may lead to excessive adjustments and discrepancies in the practice's financial records.
Claims Submission
Rejections
We perform a detailed audit of all claim rejections to identify root causes and detect recurring trends. This proactive approach helps prevent repeat errors and supports cleaner, more accurate claim submission.
Timely Filing
We analyze the submission of claims to ensure the claims are submitted within the Timely Filing Limit and any corrected claims/appeals are submitted to the carriers in a timely manner.
Clean Claims
CBS audits all charges to identify and correct any missing information—such as modifiers or diagnosis codes—to ensure clean and accurate claim submission.
Payments
Underpayments
CBS reviews all claim payments and verifies them against the contracted rates to ensure providers are reimbursed in full and that no claims are underpaid. This protects the practice from unnoticed revenue loss and ensures accurate, contract-compliant payments.
Missing Payments
CBS audits all claims marked as paid to ensure they have been reimbursed in full and that no recoverable denials have been incorrectly written off. This protects the practice from avoidable revenue loss and ensures accurate financial reporting.
Payment Methods
CBS audits the payment methods used by all insurance carriers to ensure payments are issued through EFT whenever possible. This allows the practice to receive funds faster and eliminates the risk of payments being lost or delayed in the mail.
AR Aging
CBS audits the outstanding Accounts Receivable (AR) for both insurance and patient balances. This audit helps identify workflow issues, uncover the root causes of low revenue, and provides clear insights into expected collections.
Denials
CBS audits all practice denials to identify their root causes and determine appropriate resolutions. This ensures cleaner claim submission, reduces repeat denials, and supports timely and consistent revenue for the practice.
Follow-Ups
We audit all outstanding claims to ensure proper and timely follow-up is being performed. Our review confirms that no claim remains unresolved beyond 60 days or approaches the timely filing limit without action.
Outcome of the Audit
What you'll receive after our comprehensive audit
Summary Report of the Audit
The report includes a comprehensive summary of all key measures reviewed during the audit, allowing the practice to quickly understand the findings and recommendations without needing to go through the detailed sections.
Root Causes of Revenue Loss
CBS provides the practice with a clear analysis of the root causes of revenue loss and offers actionable measures that can be implemented to prevent such issues in the future.
Corrective Action Plan
CBS provides the practice with a comprehensive action plan to eliminate rejections and denials, prevent delays in claim submission, and ensure no charges are missed.
AR Optimization
CBS provides the practice with a detailed plan to streamline the current AR, highlighting the AR buckets that require immediate attention. We also identify claims approaching the Timely Filing Limit.
Ready to Optimize Your Practice?
Contact us today to schedule your comprehensive practice audit and discover opportunities to improve your revenue cycle performance.