Independent revenue review

Medical Billing Audit: Find Out What Your Practice Is Losing

A billing audit is an outside review of your claims, payments, denials and documentation, with written findings on where revenue is being lost and what can still be recovered. Medtransic's first revenue audit is free: we review a sample of your recent claims and tell you what we would take on and your exact rate.

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Thirty charts, worked one at a timeIllustrative sample

Clean17

Underdocumented6

Wrong place of service4

Missing modifier3

Thirty charts, worked one at a time. The pattern in the last three rows is what an audit is actually for.

Key takeaways

01A billing audit is an independent review of your coding, charge capture, denials, payments, and aging balances.
02It answers two questions: what revenue is being left behind, and would your documentation hold up if a payer looked back.
03Underpayments are the least visible finding, because a claim paid below its contracted rate still posts as resolved.
04You receive written findings, the recoverable portion identified, and a prioritized list of what to fix first.
05Our billing analysis is the entry point, and the report is yours to act on with any billing team.

How We Handle Billing Audit

What the review actually does, and what you hold at the end of it.

Step 01

A Reconciliation of What You Billed Against What You Were Paid

We take your remittance detail and compare it, line by line, against the rates your agreements actually entitle you to. Short payments are separated from legitimate contractual reductions and patient responsibility, so what you get back is not a vague suspicion that payers underpay but a specific list of claims, payers, and shortfalls. That list is the part of an audit practices most often did not know was possible.

Payments compared against contracted rates / Short payments separated from valid adjustments / Shortfalls grouped by payer so patterns are visible / Findings identified while disputes are still timely

Step 02

A Documentation Read That Runs in Both Directions

Coding reviewers read a sample of your records against what was submitted, looking for two different problems at once. One is work that was performed and documented at a level your billing did not reflect. The other is billing your notes would struggle to defend if a payer asked. Practices usually brace for the second and are surprised by how much of the first turns up.

Records reviewed against submitted claims / Understated work identified, not only overstated / Documentation weaknesses flagged before a payer finds them / Findings tied to specific providers and visit types

Step 03

Root Causes Ranked by What They Cost You

Every finding gets traced to the point in your operation where it originates, whether that is registration, coverage checking, provider enrollment, documentation habit, or claim follow-up. Then the causes are ordered by annual dollar impact rather than by how many claims each touched. A problem appearing on hundreds of small claims can matter less than one appearing on a handful of large ones, and a flat list of issues hides that.

Each finding traced to its origin point / Causes ranked by yearly revenue impact / Quick corrections separated from structural ones / Enrollment and coverage gaps surfaced explicitly

Step 04

A Written Report You Can Act On Without Us

You receive the findings in writing: what we examined, what we found, what portion is realistically recoverable and within what window, and a prioritized sequence for correcting the causes. It is written for a practice owner rather than a coder, and it is yours to act on with your current billing team, a different one, or ours. An audit that only makes sense as a sales argument is not an audit.

Written findings with the reasoning shown / Recoverable amounts distinguished from expired ones / A prioritized fix sequence with owners / Usable regardless of who does your billing

Frequent Challenges in Billing Audit

These are the conditions that send practice owners looking for an outside read of their billing.

Collections Slipped and No One Can Explain Why

Patient volume held steady, your providers worked the same hours, and yet the deposits are smaller than they were a year ago. Nobody in the practice can point to the cause, because the cause is rarely one dramatic failure. It is usually several small ones running at the same time: a payer quietly reducing what it allows, a provider drifting toward more conservative documentation, a claim type that started bouncing and never got escalated. Each is invisible on its own. Together they show up as a number that keeps disappointing you.

Impact: Declining collections with no identified cause keep repeating each month

Insurers May Be Paying You Less Than Your Contract Says

When a payment arrives, it looks like a win, and it gets posted as one. Almost no practice checks whether the amount matched what the contract obligated the payer to pay. Rate updates get applied late or not at all, reduction rules get stacked incorrectly, and lines get bundled that your agreement treats as separate. Nothing in the process flags any of it, because there was no denial to investigate. This is the quietest form of revenue loss in medicine, and it compounds every month it goes unchecked.

Impact: Payments below contracted rates go unnoticed because nothing was denied

Care You Delivered Never Reached a Claim

A missed charge does not generate a rejection letter. It generates nothing at all, which is exactly why it survives. Services performed at the end of a long day, items used during a procedure, work handed between two providers, anything documented in a place the billing workflow does not routinely read: all of it can be delivered, charted, and then simply never billed. You cannot spot it by reviewing your claims, because the claim is not there. It only surfaces when someone reads the clinical record against the billing record.

Impact: Services delivered but never submitted produce no revenue and no alert

The Same Denials Keep Arriving and Nobody Has Traced Them

Your staff can probably name the payers that give them trouble. What they usually cannot produce is a ranked account of which failure points are generating the volume, what each one costs in a year, and which are fixable at the front desk versus in documentation. Without that, denial work stays a treadmill: individual claims get corrected, the underlying cause continues producing more, and the team is too busy reworking to ever look upstream.

Impact: Recurring denial causes keep generating rework that never ends

Old Balances Are Aging Into Write-Offs by Default

Aging balances rarely get a decision. They get an omission. A claim sits, then sits longer, then crosses the point where the payer will no longer consider it, and eventually someone clears the report by writing it off. No one chose to abandon that money. The workflow chose for them. Practices are often surprised by how much of what they called uncollectible was in fact still workable when it was last touched.

Impact: Aging balances cross payer deadlines and become write-offs by default

You Would Not Want a Payer Reading Your Records First

The reverse of leaving money behind is billing above what your documentation supports. That risk is harder to see from inside, because the claims paid, and paid claims feel like validation. Payers reserve the right to look back and take money returned. A practice that has never had its documentation read critically has no idea whether a retrospective review would be uneventful or expensive, and finds out at the worst possible moment.

Impact: Unreviewed documentation leaves the practice exposed to payer look-backs

What's Covered by Billing Audit

Four ways practices scope the review, depending on the question they need answered.

Revenue Recovery Audit

The version practices ask for when the numbers are down and the reason is unclear. We examine a recent period of claims and payments end to end to locate revenue that was earned but never collected, and to establish how much of it can still be pursued.

Claims and remittance review over a recent period / Missed charge identification against clinical records / Denial and aging balance recovery assessment / Recoverable total separated from expired total

Payment Variance Review

A focused reconciliation of what payers actually paid against what they contracted to pay. Where allowed amounts fall short of agreed rates, the affected claims are documented so the shortfall can be disputed while the payer's window remains open.

Allowed amounts checked against agreements / Systematic short payments distinguished from one-offs / Rate updates verified as applied on their effective date / Dispute-eligible claims listed by payer

Coding and Documentation Review

Reviewers compare a sample of clinical records against the claims produced from them, reporting both work billed below what the record supports and billing the record would not defend. Findings are returned by provider so education lands where it belongs.

Record-to-claim comparison on a defined sample / Understated and overstated billing both reported / Provider-level results for targeted education / Documentation habits behind repeat findings named

Pre-Transition Billing Assessment

For practices considering a change in billing arrangements, an independent read of current performance before the change is made. It establishes what your revenue cycle is actually producing today so any future comparison rests on measured facts rather than recollection.

Baseline established before any transition / Open balances assessed for what remains workable / Enrollment and payer setup gaps identified / Findings written for owner-level decision making

Inside Billing Audit

The Two Reasons Practices Commission a Billing Audit

Every audit starts from one of two questions, and the difference shapes what gets examined.

Two reasons practices ask for an audit

A revenue question: the practice believes it collects less than its work should produce. This review looks hardest at payments against contracts, services delivered but never billed, and balances aging out of reach.
A risk question: the practice wants to know whether its documentation would hold up if a payer looked back at claims it already paid. This review looks hardest at whether the record supports what was billed.

Most practices arrive with the first question and are glad to have the second answered too, because the same records answer both. A review built only around risk says what to stop doing and nothing about what you are owed, so scoping means deciding which comes first.

A revenue-driven audit concentrates on payment reconciliation, unbilled services, and workable aging balances.

A risk-driven audit concentrates on whether documentation supports what was billed and paid.

The same sample of records can answer both questions, which is why they are usually run together.

Scoping decides which question leads, so the sample and the reporting are built for the answer you need.

Why Underpayments Stay Hidden Until Someone Reconciles Them

A denial announces itself. An underpayment does not: the payment still arrives, posts and clears, and every report shows the claim as resolved.

Why underpayments go unnoticed

Nothing in a normal billing workflow compares what was paid with what the contract promised. That takes two things most practices do not keep together: the current contracted rates for each payer, and the line-by-line detail of what each payer allowed.

Common causes

Negotiated rate increases loaded late into the payer's system
Reductions for multiple services on one visit applied more heavily than the contract allows
Lines the contract pays separately combined into one

None of these sends an alert; each just produces a slightly smaller number. Payment disputes have deadlines that run from the payment date, so a shortfall nobody noticed for a year usually cannot be recovered.

Underpaid claims post as paid and clear as resolved, so no routine report flags them.

Detection requires reconciling remittance detail against current contracted rates, including scheduled increases.

Typical causes are administrative: late rate loading, over-applied reduction rules, and improper combining of separately payable lines.

Payer dispute windows run from the remittance date, so undetected shortfalls eventually become unrecoverable.

When a Practice Should Stop Waiting and Get One

A yearly review is a reasonable default. Some moments make an audit urgent.

When an audit cannot wait

01Collections are falling while visits hold steady, and nobody can say why. The loss is almost always inside the billing, not the schedule.
02Before renewing or renegotiating a payer contract. Without knowing whether the payer honored the current rates, you negotiate on its terms.
03Before changing billing arrangements, whether moving billing in house, out, or to a new company. A baseline taken first is the only way a later comparison means anything.
04After the people doing your coding or billing change. A new team brings different habits, however capable.
05When no outside party has ever looked. Then the audit sets a baseline that has never existed.

Revenue falling while volume holds steady is the clearest signal that the problem sits in billing execution.

An audit before a payer contract renewal establishes whether current rates have actually been honored.

A baseline taken before changing billing partners makes any later performance comparison meaningful.

Turnover in coding or billing staff changes practice habits, and an audit shows what changed with them.

What an Outside Reviewer Sees That an Internal Review Cannot

Internal review costs almost nothing and should happen often. It also has a limit that diligence cannot fix: a team checking its own work applies the same understanding that produced it.

What internal review misses

A payer rule that was misunderstood stays misunderstood in the review.
A documentation habit that drifted for two years reads as normal.
Reviews are usually the first thing dropped when claim volume rises.

An outside reviewer starts from the contract and the record rather than from the practice's habits, and has no stake in the original claims being right. The sensible arrangement is both: regular internal spot checks, plus a periodic outside review.

Internal review checks work against the same assumptions that produced the work.

It catches deviation from the practice standard but cannot see the standard itself being wrong.

Internal review is usually the first task dropped when claim volume rises.

The practical arrangement is continuous internal spot checks plus a periodic independent review.

How the Review Runs, Step by Step

Most of the work happens on our side. Your staff is involved at the start and at the end.

Scoping the Review

We agree on what gets examined before anything begins: which period of claims, which payers and providers matter most, and what prompted the review. A practice worried about a specific payer relationship gets a different sample than one preparing to change billing arrangements. Fixing the scope first keeps the audit pointed at the question you actually asked.

Gathering the Records

We request read access or exports covering claims, remittance detail, denial history, aging reports, fee schedules, payer agreements, and enrollment records, together with the clinical documentation supporting the sampled encounters. Every item is handled under the same safeguards that govern our regular billing work. This step takes little of your staff's time, and nothing further is asked of them until findings are ready.

Reconciling Payments Against Contracts

Each paid claim in the sample is compared against the rate the governing agreement calls for. Contractual reductions, patient responsibility, and coordination between plans are set aside as legitimate. What remains is unexplained shortfall, and it is documented claim by claim with the payer, the date, the expected amount, and the amount actually received.

Reading the Documentation Against the Claims

Reviewers work through the sampled encounters, comparing what the record shows was done against what was submitted and paid. Understated billing and unsupported billing are recorded separately, because they call for opposite corrections. Alongside this, the clinical record is checked for delivered services that never appeared on any claim at all.

Tracing Causes and Sizing the Opportunity

Individual findings are grouped into causes, each cause traced to where it originates and extrapolated to an annual figure so you can see what it costs across a full year rather than across a sample. Recoverable amounts are separated from amounts now past any payer's deadline, since only one of those two is worth staff time.

Delivering Findings and Deciding What Happens Next

We walk you through the written report and answer the questions it raises. You decide what to do with it. Some practices hand it to their existing biller as a work list, some use it to renegotiate a payer relationship, some ask us to execute the corrections. All three are legitimate outcomes, and the report is written to support any of them.

An Outside Billing Audit Compared With an Internal Review

	With Medtransic	Typical Internal Review
Who reviews the work	Independent reviewers with no stake in the original submissions	The same team that produced the claims reviews its own output
Underpayment detection	Paid claims reconciled against contracted rates line by line	Paid claims are treated as resolved and never re-examined
Missed charges	Clinical records read against the billing record to find work never submitted	Review starts from the claims, so services never billed stay invisible
Denial handling	Causes traced upstream and ranked by annual dollar impact	Individual denials corrected as they arrive, causes left in place
Coding direction	Both understated and unsupported billing reported	Attention concentrated on overbilling risk, undercoding overlooked
What you receive	Written findings, quantified opportunity, and a prioritized fix sequence	Verbal impressions or a spreadsheet with no ranking or plan
Frequency	A defined engagement with a start, a scope, and a delivered report	Postponed indefinitely because everyone is busy working claims

Start With a Billing Analysis

Our billing analysis is the entry point to a full audit. We review a recent period of your claims and payments and tell you what we find, whether or not you work with us afterward.

Book a Free Consultation (888) 777-0860

Get More From Your Billing Audit Process

Tell us what prompted the question, and we will scope a review that answers it. Our ongoing billing engagements are priced at 4 to 8 percent of collections.

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