Free Medical Billing Audit: Find the Revenue Your Practice Is Leaving Behind

What Is a Medical Billing Audit?

A medical billing audit is a structured review of how a healthcare practice documents, codes, submits and collects payment for its services. The goal is simple: make sure you're paid correctly for every service you provide, and that your billing is accurate enough to stand up to a payer or government review.

There are two broad types. An internal (proactive) audit is one you choose to do to find problems before a payer does. An external audit is initiated by a payer, Medicare contractor or the OIG, and usually comes with requests for records and potential repayment. A proactive audit from an independent team like Provider Concerns Solutions helps you avoid the second kind while recovering revenue you've already earned.

Why Practices Lose Revenue Without Realizing It

Most practices don't lose money in one dramatic way. They lose it in small, repeated ways that are easy to miss when you're focused on patient care:

• Denials that are never appealed. Many denied claims are simply never reworked, even though a large share of them are recoverable with a corrected claim or a short appeal.
• Undercoding. Providers who are worried about audits often bill lower E/M levels than their documentation supports, which quietly reduces reimbursement on every visit.
• Eligibility errors. Inactive coverage, wrong subscriber details or missing prior authorizations cause preventable denials that start at the front desk.
• Timely-filing write-offs. Claims that sit too long, or that bounce back and aren't resubmitted, eventually pass the payer's filing deadline and become uncollectible.
• Payer underpayments. Payers sometimes pay below contracted rates, and without line-by-line comparison these small shortfalls go unnoticed for years.

Billing Audit vs. Coding Audit: What's the Difference?

A coding audit checks whether the CPT, HCPCS, ICD-10-CM codes and modifiers on a claim are supported by the provider's documentation. It's an important piece, but it's only one piece.

A billing audit, or revenue cycle audit, looks at the whole process: patient registration, insurance eligibility, charge capture, claim scrubbing and submission, denial management, payment posting and A/R follow-up. Our free audit includes a coding sample and a full revenue cycle review, so you see both whether you're coding correctly and whether you're actually getting paid for it.

How Often Should a Practice Audit Its Billing?

Most practices benefit from a comprehensive billing audit at least once a year, with smaller focused reviews quarterly. You should also audit any time something significant changes: a new EHR or practice management system, a new billing company, new providers or locations, new payer contracts, or annual CPT and E/M guideline updates.

Free Audits for Medical, Behavioral Health and Dental Practices

We audit practices across specialties, including primary care, internal medicine, cardiology, orthopedics, behavioral and mental health, physical therapy and urgent care. For dental offices, our dental billing team reviews CDT coding, insurance verification, pre-authorizations and medical-dental cross-coding opportunities.

Because we support practices in all 50 states, we understand state-specific Medicaid rules and regional payer behavior, not just national Medicare guidelines.

Is It Safe to Share Billing Data for an Audit?

Yes, when it's done properly. Before any protected health information is shared, we sign a HIPAA Business Associate Agreement (BAA). Data is transferred through an encrypted channel, access is limited to the analysts working on your audit, and we only request the minimum data needed. You can also grant read-only system access instead of exporting files.

What happens after my audit?

You keep the report and the action plan, full stop. Many practices use it to fix issues in-house or to hold their current billing company accountable. If you'd like help putting the fixes in place, our team offers end-to-end revenue cycle management, denial management, medical coding and claims processing, with transparent pricing and no upfront cost.