What does an RCM audit review?
Our audits review coding accuracy, documentation, denials, missed charges, and compliance risk, and we provide written findings and recommendations.
RCM and Medical Billing Audits
Independent audits of your billing, coding, and claims that look for missed revenue and compliance risk, with written findings and recommendations.
Request an Audit
All audits are performed under a Business Associate Agreement (BAA).
Works Alongside Your Current Team
An independent audit fits alongside your in-house billing staff or your current billing company. Nothing changes in your operations unless you decide it should.
Each audit is scoped and priced based on your practice's size and needs.
Paid Accurately for the Work You Do
Our audits look at both sides of your revenue cycle: revenue your practice may be missing, and coding and billing practices that could create compliance risk. Accurate coding means being paid for the care you provide, no more and no less.
Revenue Review
We look for:
- Missed or unbilled charges
- Undercoding and missing modifiers
- Underpayments compared to payer contract rates
- Denials that were not appealed or reworked
- Timely filing write-offs and aging A/R
- Eligibility and authorization gaps at the front end
Compliance Review
We review:
- Coding accuracy against documentation
- Overcoding and unsupported levels of service
- Modifier usage
- Medical necessity documentation
- Payer-specific billing requirements
Professional RCM Auditing
An independent look at your revenue cycle and billing practices
Comprehensive Review
A review of your revenue cycle from patient registration through final payment.
Compliance Auditing
Review billing practices against applicable regulatory requirements and industry standards.
Performance Analysis
Detailed analysis and benchmarking against industry standards.
Risk Identification
Review of billing and coding practices for potential compliance risks.
Types of RCM Audits
Comprehensive auditing services tailored to your needs
Revenue Cycle Audit
Complete end-to-end review of your revenue cycle processes, from patient registration to final payment
Deliverables:
- Process analysis report
- Efficiency recommendations
- Cost-benefit analysis
- Implementation roadmap
Coding Compliance Audit
Comprehensive review of coding practices to assess accuracy and compliance
Deliverables:
- Coding accuracy assessment
- Compliance findings
- Training recommendations
- Documentation improvements
Claims Management Audit
Analysis of claims submission, denial patterns, and resolution processes
Deliverables:
- Denial analysis
- Process recommendations
- Workflow improvements
- Performance benchmarks
Ongoing Review and RCM Reporting
After your initial audit, we can continue reviewing your revenue cycle on a regular schedule, with ongoing reports your administrators and physicians can use to track performance over time.
Ongoing reporting can include:
- Denial trends and top denial reasons
- A/R aging by payer
- Payer performance and payment patterns
- Collections and charge activity
- Recommendations and follow-up from each review
Ongoing reporting works whether your billing is handled in-house, by another billing company, or by Zenith.
Learn about Comprehensive RCM Oversight & AnalyticsWhat You Receive
What your audit includes
Review of missed charges, underpayments, denials, and aging A/R
Review of coding and billing against payer requirements
Recommendations for workflow improvements
Comparison to common industry benchmarks
A written report your team can act on
A findings review meeting with our team
Frequently Asked Questions
How is an audit priced?
Each audit is scoped and priced for the practice, based on the areas reviewed and the volume of claims involved.
Can you audit our billing while we keep our current team?
Yes. Audits are designed to work alongside your current billing team or company.
What happens after the audit?
We walk you through the findings, and ongoing reporting and analytics are available if you want continued visibility.
Professional Medical Billing Services
We provide medical billing and end-to-end revenue cycle management services for medical providers and ambulatory surgery centers nationwide.