Billing & Coding Audit Services waqas khan October 19, 2024

Gain Clarity and Compliance with Expert Billing Audits

Find Revenue Leaks Fast with Our Medical Billing and Coding Audits

We don’t just manage denials. We eliminate their root causes. With real-time claim tracking, A/R cleanup, and expert appeals, our team helps healthcare providers recover lost income and stay ahead of payer roadblocks.

  • Accurate billing and coding audits made easy for any practice size
  • Scalable audit models including risk-based and focused evaluations
  • Faster reimbursements with 99% first-pass resolution
  • HIPAA-compliant audit reports that meet payer and regulatory standards
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Medical Billing and Coding Audit Services - ProMBS

Medical Billing and Coding Audits Built for Revenue Integrity

Small coding mistakes, missed modifiers, and outdated payer guidelines can quietly cost your practice thousands of dollars in lost revenue. These issues often go unnoticed but have a cumulative impact on your bottom line, reimbursements, and compliance status.

We provide comprehensive, end-to-end medical billing and coding audit services designed to identify every error, outdated process, or gap in your billing workflow. Our experts meticulously review your claims, benchmark performance, and highlight where revenue is being lost. More importantly, we deliver a clear, actionable plan that helps your team recover missed revenue, correct systemic issues, and stay fully compliant with evolving payer regulations — ensuring your practice runs efficiently and profitably.

Billing and Coding Audits for Revenue Integrity - ProMBS
medical billing and coding audit services - ProMBS

Risk-Based Billing and Coding Audit

We focus on high-risk CPT codes, frequent denials, and payer-specific red flags. This audit type helps you uncover issues that could lead to penalties or payer reviews. You get actionable insights to make corrections before problems grow.

Targeted Billing and Coding Audit

If you're facing problems in a specific area like anesthesia billing, modifier misuse, or recurring underpayments, this audit isolates the cause and gives you clear steps to fix it. It works best when you're already aware of specific revenue challenges.

Scheduled Compliance Audit

Our recurring audits, conducted quarterly, semi-annually, or annually, track your billing accuracy and ensure compliance with changing payer guidelines. These reviews help stabilize your revenue and maintain long-term financial health. We make medical billing and coding audits straightforward, focused, and results-driven. Each audit includes a clear report, prioritized recommendations, and dedicated support to help you improve accuracy and protect your bottom line.

How We Audit Your Billing and Coding for Maximum Accuracy

We don’t just scan claims. We investigate every layer of your billing process to catch what others miss. Our medical billing and coding audit services are built to identify coding errors, lost charges, and payer compliance risks that impact your bottom line. Here’s how we do it:

Understand Your Billing Rules

We begin by reviewing your internal billing policies, coding practices, and payer contracts. This gives us a clear picture of how your billing system operates and where errors are most likely to occur.

Analyze the Data

We dig into your EHR data, claims history, denials, and reimbursements. This step helps us identify billing and coding errors, claim patterns, and high-risk areas affecting performance.

Review Documentation

Our team inspects clinical documentation, CPT and ICD-10 code usage, modifier application, and medical necessity alignment. This hands-on coding audit helps us ensure accuracy and uncover hidden issues.

Share Clear Findings

You receive a detailed report showing what’s wrong, why it matters, and how to fix it. We provide a clear action plan that helps you correct billing errors, reduce future denials, and improve claim acceptance.

Guide Your Team Forward

We don’t leave you with a list. We provide follow-up support, optional coder training, and compliance check-ins so your team can implement changes confidently and avoid repeated mistakes.

Billing and Coding Services for Maximum Accuracy - ProMBS

Why Healthcare Providers Prefer Our Medical Billing and Coding Audit Services?

We combine deep audit expertise with real-time support to make your billing process faster, cleaner, and fully compliant. Our medical billing and coding audit services uncover hidden revenue gaps, reduce denial rates, and strengthen claim accuracy without interrupting your team’s workflow.

Each audit is a strategic opportunity to elevate performance, not merely a compliance task. From patient data handling to audit documentation, every step is secure, seamless, and fully HIPAA compliant. You gain clarity, accuracy, and faster payments without any back-and-forth delays.

Why Healthcare Facilities Choose Our Medical Billing Audit Services?

Rapid Revenue Recovery
0 Days
First-Pass Resolution
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Denial & Rejection
0 % - 10%
Short Turnaround Time
0 Hours
Electronic Claim
0 %
Electronic Payment
0 %
Client Retention
%
Revenue Increase
0 %
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    Specialties We Strengthen With Our Medical Billing and Coding Audits

    We tailor every audit to the rules, payer edits, and documentation demands of your specialty. That focus allows us to spot code-level errors fast, improve first-pass claim accuracy, and protect your revenue against payer take-backs.

    By combining specialty-specific knowledge with proven medical billing and coding audit services, we help providers cut denial rates, reduce audit risk, and unlock greater reimbursement.

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    Our Expertise

    Medical Billing Software We Leverage for Revenue Cycle Management

    Here are some Industry top listed EHR being operated by us.

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    Our Esteemed Clients' Testimonials

    Frequently Asked Questions
    A Medical Billing and coding audit is a comprehensive review of your healthcare practice’s billing process, coding accuracy, documentation quality, and claim outcomes. It’s designed to detect compliance issues, underbilling, overbilling, and patterns of denied or rejected claims. By auditing past claims and documentation, we help ensure that your revenue cycle is optimized and aligned with industry standards.

    Pro Medical Billing Solutions provides more than just a standard billing audit — we combine expert analysis with actionable improvements. Our certified coders and billing auditors not only identify revenue loss and compliance issues, but also implement corrections, retrain staff if needed, and offer full transition into our billing services. This hands-on approach results in immediate improvements and long-term financial gains.

    Our audit process is structured and systematic. We start by collecting a sample of recent claims, then review coding accuracy (CPT, ICD-10, HCPCS), documentation completeness, modifier usage, and payer rule compliance. We analyze trends in claim denials, delays, and rejections. The result is a comprehensive audit report showing where your revenue is leaking — and how to fix it.

    A billing audit helps identify weaknesses in your revenue cycle — including missed charges, under-coded services, and billing delays. By correcting these problems, your practice submits cleaner claims, gets paid faster, and reduces accounts receivable (A/R) days. Our audits also provide insights into payer performance and internal staff workflows, giving you full control over your revenue.

    Any medical practice can benefit — but audits are especially valuable for solo providers, specialty clinics, and mid-sized practices experiencing irregular cash flow, frequent denials, or documentation challenges. Whether you’re transitioning staff, scaling operations, or facing payer issues, Pro Medical Billing Solutions can help uncover what’s holding your revenue back.
    At minimum, practices should audit their billing processes annually to ensure ongoing compliance and accuracy. However, for high-volume specialties or practices that have experienced claim denials, documentation changes, or staff turnover, we recommend quarterly audits. Regular audits reduce risk, recover revenue faster, and improve long-term financial performance.
    During our audits, we frequently uncover undercoding, upcoding, incorrect modifier use, non-compliant documentation, billing for unverified insurance, and failure to follow payer-specific rules. These issues lead to denied claims, delayed payments, or even audit penalties. Correcting these not only protects your practice but also boosts collections.
    Yes. Every audit concludes with a detailed report outlining all findings, including compliance risks, financial impact, documentation gaps, and coding discrepancies. We provide a priority-based action plan and offer hands-on guidance to implement corrections and optimize future billing.
    Many practices continue working with us after the audit phase. We make it easy to transition into our full-service medical billing solution, where we correct coding, resubmit denied claims, streamline workflows, and provide real-time reports. This transition ensures that the problems found in the audit don’t return and your revenue cycle stays healthy.
    Yes — in fact, this is what most of our clients choose to do. Once the audit is complete and pain points are identified, we can take over your billing, manage coding, claims submission, and denial follow-ups. You get expert oversight, cleaner claims, and better financial results without adding overhead.
    We use certified coders and billing experts trained in CMS, Medicare, and payer-specific guidelines. Our audit tools include claim scrubbers, documentation checklists, and payer policy databases. We also follow strict HIPAA protocols and keep your data secure throughout the process.
    Depending on the size of your practice and the severity of issues, you could recover thousands in missed reimbursements. Most clients see a 15–30% improvement in collections within 90 days of applying audit-driven changes. We also reduce future loss by correcting patterns that often go unnoticed.
    We audit and support over 25 medical specialties including family medicine, cardiology, pediatrics, behavioral health, orthopedics, OBGYN, dermatology, and more. Each specialty is assigned auditors and coders with experience in that field to ensure accurate and relevant findings.
    Yes. As part of our audit service, we review denied claims to understand why they were rejected. We then resubmit corrected claims where possible, recover lost revenue, and adjust your process to prevent repeat denials.
    Getting started is simple. Just contact us for a free consultation. We’ll assess your practice needs, gather a sample of claims, and begin the audit. From there, we’ll walk you through your results and either support your in-house corrections or transition you to our full-service billing solution.
    What Sets Our Medical Billing and Coding Services Apart
    Quick Turnaround Times
    Monthly Coding Audit
    Timely AR Follow-Up
    Revenue Cycle Optimization
    24/7 Helpdesk Support
    Expert Medical Billers
    Advance Cash Flow
    Reasonable Pricing
    Qualified Coding Auditors
    Real-Time Insurance Verification
    Auditing Complex Denials
    Unlimited Physician Credentialing
    30 Days Free Trial
    Denial Management
    Healthcare Analytics
    Medical Billing Consultation
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    Specialties
    Head Office | Houston

    857 Tristar, Suite A1,
    Webster, TX 77598, US.

    Nevada Office

    2300 W Sahara Avenue, Suite 800,
    Las Vegas, NV 89102, US.

    Colorado Office

    1600 Broadway, Suite 1600,
    Denver, CO 80202, US.

    Las Vegas Office

    732 S 6TH ST, STE R,
    LAS VEGAS NV 89101, US.

    Virginia Office

    5600 General Washington Dr Ste B207,
    Alexandria, VA, 22312, US.

    Thousands of providers growing their practice with PROMBS.

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    Office locations - Pro medical billing solutions
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