Comprehensive Medical
Billing &
Coding Audits
What Are Medical Billing Audits?
Medical billing and coding audits, also referred to as medical audits, are essential evaluations to ensure billing claims and coding documentation comply with industry standards. Certified auditors review patient charts and billing records to verify the accuracy of codes and their alignment with the care provided. Much like routine health checkups, medical audits identify issues early, allowing providers to address problems before they escalate.
Audits play a crucial role in detecting improper coding, incomplete documentation, missed charges, and noncompliance with reimbursement guidelines. By correcting errors proactively, they help prevent denied claims and penalties while strengthening the provider’s revenue cycle. Regular, thorough audits ensure accurate coding, complete records, optimized reimbursements, adherence to payer policies, and overall financial stability.
How Does SMBT Medical Coding Audit Company Help?
SMBT offers professional medical billing audit services to safeguard the accuracy and integrity of your billing and coding processes. Medical billing and coding are intricate tasks prone to errors, requiring vigilant oversight. Our comprehensive coding audit and compliance services act as a safety net, ensuring the accuracy of your medical claims billing process.
Our experienced auditors meticulously review documentation, coding choices, and submitted claims to uncover inaccuracies and identify areas for improvement. These insights help healthcare facilities achieve error-free medical coding and maximize revenue capture.
Equally important, our high-quality audit program prevents compliance violations and fraud that could result in fines, penalties, or reputational damage. SMBT’s audit services serve as a cornerstone for clinical, financial, and regulatory excellence, providing healthcare organizations with the assurance they need to thrive.
Explore Our Medical Billing Audit Services
Medical Coding Audit
We provide thorough medical coding audits for all types of medical records, including inpatient, outpatient, professional fee (profee), and home health, ensuring accuracy and compliance across all healthcare settings.
Medical Billing Audit Services
We conduct detailed audits for all claim types, including Medicare, Medicaid, commercial insurance, and self-pay, ensuring accuracy and compliance across the board.
Government & Payor Audit
We assist providers in preparing for and responding to government and payor-mandated audits, including TPE, RAC, OIG, DMEPOS, and Medical Necessity.
Clinical Audits for Quality
We perform both internal and external clinical audits to evaluate the quality, safety, and effectiveness of your patient care and clinical outcomes.
Aging Claims Audit
Our collection aging audit helps boost your cash flow by identifying errors in aged claims and refiling denied claims for prompt resolution.
Medicare Chart Audits
We audit Medicare patient charts to ensure all billed amounts are justified and compliant, ensuring your practice receives full and fair reimbursement.
Unsure About the Quality
of Your Medical Records?
Let us help you gain clarity and ensure accuracy with our expert audits!
Solve Your Billing Challenges with Our Auditing Solutions
Inaccurate billing and coding can significantly impact your practice. Denied claims result in lost revenue, backlogs cause cash flow issues, and errors lead to audits and penalties. Our medical billing and coding audit service identifies inefficiencies in your workflows. After a thorough analysis of your team, processes, and technology, we provide targeted recommendations to improve compliance and optimize your revenue cycle.
Using advanced NLP and machine learning, we analyze medical records to detect coding errors, optimize reimbursements, and prevent claim denials.
Non-compliance can lead to penalties, fines, audits, investigations, lawsuits, sanctions, and exclusion from federal health programs.
Our advanced billing analytics engine detects trends, outliers, and red flags in real-time, enabling targeted audits to mitigate compliance risks and prevent government scrutiny.
Billing errors can threaten the financial stability, cash flow, profitability, and long-term sustainability of healthcare organizations.
Our comprehensive billing audit carefully reviews each claim for accuracy, ensuring maximum appropriate reimbursement to support the financial health and long-term stability of your healthcare organization.
Coding errors can result in claim denials, revenue loss, overcharges, underpayments, patient dissatisfaction, and potential legal consequences.
Reimbursement reductions may compel healthcare providers to cut staff, limit services, close practices, or accept fewer Medicare patients.
Our AI-powered billing audit system analyzes your claims data to uncover missed revenue opportunities and compliance risks, ensuring every dollar is captured before reimbursement cuts
Optimizing Your Medical Billing and Coding Processes
Internal Audit Services
We perform a thorough review of your internal processes and documentation to ensure they align with industry standards. Additionally, we provide actionable recommendations to help providers enhance their performance.
External Audit Services
We conduct an independent review of your claims and payments from third-party payers, such as Medicare and Medicaid. Our services include resolving billing disputes, recovering underpayments, and managing aged receivables.
Prospective Audit Services
We review your claims before submission to ensure they are accurate, complete, and compliant. Our proactive approach helps prevent denials, rejections, and delays in reimbursement.
Retrospective Audit Services
We review your claims after they’ve been processed by payers to identify any errors. Our team helps correct mistakes, appeal denials, and optimize your revenue cycle for better financial outcomes.
Comprehensive Audit Services
We offer a thorough audit of your entire medical practice, reviewing every aspect of your operations—from coding and billing to documentation and compliance—to ensure accuracy and efficiency.
Missing Revenue? We’ll Recover It.
Our expert audits thoroughly analyze your claims data and billing records to identify and recover improper payments and missed revenue opportunities.
SMBT Auditing Solutions Overview
Ensure Billing Compliance
with Our Coding Audit
Service
Ensuring Accurate Coding
At our medical coding audit company, assessing coding accuracy is a key focus. We carefully review medical charts to ensure that codes accurately reflect diagnoses, procedures, and complexity levels. Proper coding is essential for correct reimbursement and compliance with guidelines. Our audits identify issues such as upcoding or undercoding and provide recommendations for correction. With our expert support, providers can be confident their coding meets industry standards and captures the full reimbursement value owed.
Enhancing Charge Capture Accuracy
Charge capture accuracy is another critical area we focus on. We ensure that all services rendered and supplies used are correctly captured in the billing at the appropriate rates. Missed charges result in lost revenue, which is why our auditors meticulously compare medical records with itemized billing statements. We identify any overlooked charges and provide recommendations to improve your charge capture processes. Our aim is to maximize your reimbursement by addressing gaps where legitimate charges may be missed.
Auditing Provider-Payer Contracts
Some other areas we examine are proper application of insurance payor contracts and fee schedules as well as accuracy of data entered into the billing system. Invalid fee schedules and data entry errors can sabotage reimbursement. We verify compliance with payer contracts and recommend process improvements to enhance billing system accuracy. Our comprehensive audits cover all key facets to maximize claim quality and revenue integrity.
Auditing Billing Documentation for Compliance
A comprehensive documentation review is a key component of our billing audit process. We evaluate whether medical records provide clear and consistent documentation to support the coded claims. Complete and accurate documentation is essential to justify charges and withstand payer scrutiny. Our team identifies any documentation issues, such as vagueness, inconsistency, missing signatures or credentials, and lack of medical necessity. We offer guidance to enhance documentation practices, ensuring better claim defense and improved audit outcomes.
How Our Coding Audit Services Ensure Billing Compliance
Receive Post-Audit Reports Directly to Your Inbox
We deliver detailed reports that offer a comprehensive view of your coding and billing operations. Below are some key reports you can request after the audit
Charge Capture Analysis Report
This report evaluates your charge capture process to pinpoint areas of revenue leakage. We focus on front-end charge capture issues that result in missed charges and lost revenue. The report includes actionable recommendations to improve charge capture efficiency and maximize revenue.
Coding Audit Report
Our coding audit reviews a sample of charts to identify errors and opportunities for improvement. The report highlights coding accuracy rates, the financial impact of errors, and outlines education needs for coders. Additionally, we provide a risk analysis to help prioritize auditing efforts and enhance overall coding practices.
Denials Analysis Report
This report analyzes your denial data to identify the primary denial reasons, determine if appeals are necessary, and uncover opportunities to prevent future denials. Our findings provide actionable insights to help reduce denials and improve your overall revenue cycle performance.
Compliance Risk Assessment Report
This report evaluates your compliance risk in areas like coding and billing documentation, Medicare regulations, and HIPAA. We provide a risk scorecard and a detailed roadmap to help strengthen your compliance program and reduce potential risks.
Revenue Cycle Performance Report
How do your KPIs measure up? Our benchmarking report compares your metrics to industry standards, helping you identify areas for improvement. We analyze key indicators such as first-pass resolution, net collection rate, A/R days, and more.
Comprehensive Medical Chart Audits and Validations
Medical Chart Audits
Our clinical auditors conduct detailed medical chart reviews, including inpatient, outpatient, radiology, DME, and mammography audits. We evaluate the quality of care delivered, ensure compliance with coding and documentation standards, and confirm adherence to clinical guidelines.
Are Your Claims 100% Accurate?
Ensure your practice runs smoothly with a
complimentary claims audit. Discover errors,
improve accuracy, and maximize revenue with
our expert evaluation.