Coding & Chart Abstraction Audit
We compare signed provider encounter notes and operative reports directly against billed CPT, ICD-10-CM, HCPCS codes, and E/M complexity levels.
Medical Billing & Coding Audit Services for Healthcare Practices
Doc Flow RCM conducts forensic medical billing, coding, and revenue cycle audits to uncover hidden revenue leakage, identify payer underpayments, resolve recurring denial patterns, and ensure 100% OIG and CMS compliance for medical practices across the United States.
- ✓ Clinical Chart-to-Claim Coding & E/M Leveling Audits (CPMA Certified)
- ✓ Uncover Missed Charges, Unbilled Modifiers & Payer Underpayments
- ✓ Deep-Dive Aging A/R, Denial Root-Cause & Write-Off Reviews
- ✓ OIG, CMS, LCD/NCD & HIPAA Regulatory Compliance Protection
12% – 18%
Average Uncovered Revenue Leakage
99.4%
Post-Audit Coding & Billing Accuracy
45%
Reduction in Recurring Claim Denials
5 – 7 Days
Complete Executive Audit Turnaround
360-Degree Medical Billing Audit From Clinical Documentation to Bank Deposit
Doc Flow RCM’s certified auditors examine every layer of your revenue cycle to pinpoint where money is being left on the table and where compliance risks exist.
Charge Capture & Leakage Audit
We cross-reference appointment schedules, surgical logs, and EHR orders against submitted claims to identify unbilled encounters, supplies, and add-on codes.
Fee Schedule & Underpayment Audit
We audit paid ERAs and EOBs against your contracted payer fee schedules and Medicare allowables to catch silent underpayments and improper reductions.
Denial Root-Cause Analysis
We categorize ANSI CARC/RARC denial trends across front-desk eligibility, prior authorizations, NCCI bundling, and medical necessity to stop repeat rejections.
Aging A/R & Timely Filing Audit
Forensic evaluation of 30, 60, 90, and 120+ day unpaid claims to assess collectability, stalled follow-ups, and timely filing exposure.
Payment Posting & Write-Off Audit
We inspect contractual adjustments, administrative write-offs, unapplied cash queues, and credit balances to uncover unauthorized balance write-offs.
OIG & CMS Compliance Review
Proactive risk assessment for upcoding, unbundling, modifier misuse (25, 59), and medical necessity documentation to shield your practice from RAC/CERT audits.
Front-End & Enrollment Audit
We review front-desk eligibility workflows, copay collection rates, and provider payer enrollment/EDI setups that impact claim adjudication.
How Our Medical Billing Audit Process Works
We conduct a structured, non-disruptive 6-step audit inside your existing EHR and Practice Management system, delivering actionable findings within days.
01
Scope & Data Sampling
We define audit goals and pull a statistically valid sample of encounters, claims, ERAs, and A/R reports.
02
Chart-to-Claim Audit
Certified CPMA/CPC auditors compare clinical notes against billed CPT, ICD-10, E/M levels, and modifiers.
03
A/R & Denial Forensics
We analyze aging 30–120+ day A/R buckets, denial reason codes, and unworked claim rejections.
04
Payment & Write-Off Review
Posted EOBs, contractual adjustments, and bank deposits are verified against payer fee schedules.
05
Executive Audit Report
You receive a comprehensive scorecard detailing dollar-value leakage, error rates, and compliance gaps.
06
Recovery & Corrective Plan
We walk your leadership through a step-by-step action plan to recover lost revenue and fix workflow bottlenecks.
Four Critical Pillars of Our Revenue Cycle & Compliance Audit
Most practices lose 10% to 18% of collectable revenue due to unnoticed coding habits, auto-write-offs, and unworked denials. Our 4-pillar audit leaves no stone unturned.
1. Clinical Documentation & Coding Accuracy
- ✓Evaluation & Management (E/M) undercoding and overcoding analysis
- ✓Verification of anatomical and functional modifiers (25, 59, XU, 50, 51)
- ✓Diagnosis-to-procedure linkage and LCD/NCD medical necessity validation
- ✓Detection of unbilled ancillary services, injections, and J-code supplies
2. Charge Capture, Scrubbing & Claim Submission
- ✓Reconciliation of EHR appointment schedules against billed claim batches
- ✓Audit of average charge lag days from encounter date to claim submission
- ✓Review of unworked clearinghouse rejections (277CA) sitting in queues
- ✓Assessment of NCCI bundling edits and Medically Unlikely Edits (MUEs)
3. A/R Aging, Denials & Contractual Write-Offs
- ✓Breakdown of A/R aging over 60, 90, and 120+ days by payer and reason
- ✓Audit of premature or unauthorized staff write-offs and adjustments
- ✓Identification of claims approaching payer timely filing deadlines
- ✓Evaluation of appeal quality and overturn success rates on denied claims
4. Payer Reimbursement & OIG Compliance
- ✓Comparison of actual ERA payments against contracted payer fee schedules
- ✓Audit of unapplied cash, suspense ledgers, and patient credit balances
- ✓Provider signature, cloning, and incident-to/split-shared billing compliance
- ✓Readiness assessment against Medicare RAC, CERT, and commercial payer audits
The Financial Difference Between an Unaudited Practice & a Doc Flow RCM Audited Practice
Even high-volume practices with internal billers or external billing agencies experience silent revenue leakage without independent periodic audits.
Without Regular Billing Audits
Hidden risks draining practice collections every month
- Providers systematically downcode E/M visits out of fear of payer audits
- Billers write off denied claims as "contractual adjustments" instead of appealing
- Payers silently underpay 5%–10% below contracted fee schedule rates
- Completed procedures and J-code drugs remain unbilled in EHR drafts
- High vulnerability to payer recoupment demands and OIG penalties
With a Doc Flow RCM Billing Audit
Complete financial clarity, compliance, and revenue optimization
- Confident, compliant E/M and procedure coding backed by clinical documentation
- Strict controls preventing unauthorized write-offs and premature adjustments
- Every underpaid ERA line item flagged and appealed for full contract recovery
- 100% reconciliation between daily schedules, operative logs, and billed claims
- Audit-proof clinical records aligned with CMS, OIG, and payer LCD guidelines
What You Receive in Your Executive Billing Audit Package
We don’t hand you vague spreadsheets. You receive a clear, executive-ready audit package with exact dollar figures and a prioritized recovery roadmap.
Deliverable 01
Revenue Leakage Scorecard
A quantified dollar-value breakdown of missed charges, undercoded encounters, unworked rejections, and improper write-offs.
Deliverable 02
Provider-by-Provider Coding Matrix
Individual accuracy benchmarks for each physician or mid-level provider covering ICD-10 specificity, CPT selection, and E/M distribution curves.
Deliverable 03
Aging A/R Collectability Report
An honest assessment of your 30, 60, 90, and 120+ day A/R buckets—separating immediately recoverable cash from timely filing losses.
Deliverable 04
Denial Root-Cause Breakdown
Categorization of your top denial codes (CO-16, CO-45, CO-97, CO-197, CO-50) with specific front-end and back-end fixes.
Deliverable 05
Compliance & Risk Assessment
Identification of documentation gaps, modifier vulnerabilities, and OIG compliance risks before an external payer audit occurs.
Deliverable 06
1-on-1 Provider & Staff Debrief
A live consultation with our lead CPMA auditor to review findings, educate providers on CDI improvements, and outline next steps.
Specialty-Specific Medical Billing Audits Across the United States
Our auditors hold specialty credentials and deep experience across high-complexity surgical, interventional, and outpatient medical practices.
Interventional Pain Management
Psychiatry & Behavioral Health
Orthopedics & Spine Surgery
Cardiology & Vascular
Primary Care & Internal Medicine
General & Specialty Surgery
Ambulatory Surgery Centers (ASC)
ENT & Otolaryngology
Neurology & Neurosurgery
Gastroenterology & Endoscopy
Radiology & Diagnostic Imaging
Urgent Care & Multi-Specialty
Frequently Asked Questions About Medical Billing Audits
Clear answers on how our independent billing and coding audits work for your practice.
Q1. How often should a medical practice conduct an independent billing and coding audit?
Industry best practices and OIG compliance guidelines recommend conducting a baseline comprehensive audit annually, supplemented by quarterly spot-audits (10–20 charts per provider) to catch new payer rule changes or coding drift early.
Q2. Can you audit our current in-house billing team or third-party billing company without disrupting daily operations?
Yes. Our audit is 100% confidential and non-disruptive. Using read-only EHR/PM access or exported reports, we evaluate claim accuracy, write-offs, and A/R follow-up performance without slowing down your daily clinic workflow.
Q3. What is the difference between a prospective audit and a retrospective billing audit?
A prospective audit reviews clinical charts and charges before claims are submitted to payers—preventing denials upfront. A retrospective audit examines already adjudicated claims, EOBs, write-offs, and aging A/R to recover underpayments and fix systemic billing errors. We offer both.
Q4. Who performs the medical billing and coding audits at Doc Flow RCM?
Every audit is conducted by AAPC and AHIMA-credentialed specialists—including Certified Professional Medical Auditors (CPMA) and senior revenue cycle analysts with over 10+ years of specialty billing experience.
Q5. If your audit uncovers unpaid aging A/R or underpaid claims, can your team help us recover that money?
Absolutely. Once we deliver your Executive Audit Report, you can either use our roadmap internally or engage Doc Flow RCM’s A/R recovery and denial management team to appeal, rebill, and collect the uncovered revenue for you.
Ready to Uncover Hidden Revenue Leakage & Protect Your Practice Compliance?
Schedule a confidential Medical Billing & A/R Audit with Doc Flow RCM. Get a complete executive scorecard of your coding accuracy, denial trends, and recoverable revenue within 5–7 business days.