Billing & Coding Compliance Audits
Thorough audits of your billing and coding practices to identify compliance gaps, reduce fraud risk, and ensure you're capturing the revenue you've earned — without crossing regulatory lines.
Why Billing Audits Matter
Billing and coding errors are among the most common compliance risks in healthcare — and among the most heavily penalized.
False Claims Act Exposure
Improper billing can trigger False Claims Act liability with penalties up to three times the amount of the false claim, plus per-claim fines.
OIG Audit Risk
The OIG Work Plan targets specific billing practices each year. Proactive auditing identifies vulnerabilities before regulators do.
Revenue Leakage
Under-coding and documentation gaps mean you may be leaving legitimate revenue on the table. Proper coding captures what you've earned.
Our Audit Services
Comprehensive billing and coding review from pre-submission to ongoing monitoring.
Prospective Audits
Pre-billing review of claims before submission to catch errors, ensure proper documentation, and prevent compliance issues before they occur.
Retrospective Audits
Post-submission review of paid claims to identify patterns of overcoding, undercoding, unbundling, and other billing irregularities.
Focused Audits
Targeted reviews of specific service lines, CPT codes, or billing patterns identified as high-risk based on OIG guidance or internal data.
Documentation Audits
Evaluate whether clinical documentation supports the codes billed, including medical necessity, level of service, and modifier usage.
Provider Education
Following audit findings, we provide targeted education to providers and coding staff on documentation requirements and coding accuracy.
Ongoing Monitoring
Establish a continuous monitoring program with regular sample audits and trend analysis to maintain billing compliance over time.
Common Findings
Our audits frequently uncover issues that organizations didn't know they had — issues that could trigger investigations, overpayment demands, or False Claims Act exposure.
Proactive Protection
A proactive billing audit demonstrates your organization's good-faith commitment to compliance — a critical factor if questions ever arise.
- Identify and correct errors before regulators find them
- Reduce False Claims Act and Stark Law exposure
- Capture legitimate revenue through proper coding
- Build a defensible compliance record
Our Process
Scope & Planning
We define audit scope, sample size, service lines, and review criteria based on your organization's risk profile and OIG priorities.
Record Collection
We gather claims data, medical records, and supporting documentation for the defined sample set.
Expert Review
Our team reviews each record against coding guidelines, payer requirements, and compliance standards.
Findings Report
We deliver a detailed report with error rates, patterns, financial impact, and specific examples for each finding.
Remediation Plan
We provide targeted recommendations, corrective actions, and education to address identified issues and prevent recurrence.
Protect Your Organization
Don't wait for an audit to discover billing and coding issues. A proactive review identifies risks, protects revenue, and builds a stronger compliance foundation.
Schedule a Billing AuditReady to Strengthen Your Compliance Program?
Schedule a free consultation with our compliance experts and discover how we can help protect your healthcare organization.