Insurance Companies

Our Audits Address Three Distinct Areas:

Medical Record Audit

If a compliance audit identifies a possible medical record documentation issue, a completed medical record audit is performed. This examination involves researching and documenting the precise location within the medical record of every billed item and service on the itemized statement, and identifying charges that are not substantiated by the medical record. Our report will also alert you to any items and services that were documented but not billed.

Compliance Audit

hospital bill auditing

This area yields more dollars than standard medical record audits by identifying the non-compliance billing techniques most medical providers and hospitals use. The areas addressed by this review include: Verification that the items and services billed are not in-fact already included, billed and incorporated into another charge generating duplication of charges; unbundling of items and services; incorrect use of CPT/HCPCS codes that may be billed in conflict with federal billing guidelines and/or AMA guidelines.

We review every line item of an itemized statement for possible duplication, unbundling, undocumented, non-billable charges, and data entry mistakes that produce in-appropriate charges and other errors.

Fair and Reasonable Price Analysis:

This portion of our audit evaluates to verify that billed charges are in comparison with the facility’s actual cost for services provided and the most usual reimbursement accepted from other managed care payers.

We review each line item of every bill from every provider, looking for possible duplication, unbundling, undocumented, non-billable charges, data entry mistakes that produce inappropriate charges and other errors.

Every Payer Has a Right to a Clean Claim. Call (855) 203-7058 Now

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