Be On the Same Page With Your Payers & Patients
You work hard to provide quality care — but are you getting paid what you deserve? Errors in medical billing can lead to lost revenue, denied claims, and legal trouble. Our audit specialists review your codes and claims for accuracy, compliance, and revenue optimization.
Essential Evaluations That Protect Your Revenue
Medical billing audits are essential evaluations that ensure your billing claims and coding documentation fully comply with payer regulations. Much like a routine checkup catches health issues early, a billing audit uncovers improper coding, incomplete documentation, missed charges, and noncompliance before they become penalties — strengthening your revenue cycle and long-term financial stability.
Medical Practices Who Can Use Our Audit Services
Whether you're a solo provider just getting started or a multi-location group, our team scales to fit how your practice actually operates.
- Solo Physicians
- Independent Practice Groups
- Medical Clinics
- Physician Groups
- Hospital-Owned Practices
- Urgent Care Centers
- In-Home Health Providers
- Laboratories
- Freestanding ER Centers
- Hospitals
- Non-Emergency Medical Transport
- New & Growing Practices
Meticulous Analysis That Protects Your Practice
Our auditors take a detailed, in-depth approach to reviewing clinical documentation, coding selections, and submitted claims — uncovering inaccuracies, identifying compliance risks, and highlighting revenue opportunities. That same diligence helps you avoid billing compliance violations and fraudulent-practice exposure that can lead to fines, penalties, and reputational damage.
- Coding Accuracy Review
- Documentation Compliance
- Charge Capture Analysis
- Payer Guideline Alignment
- Denial Root-Cause Review
- Ongoing Monitoring
Six Core Medical Billing Audit Offerings
Medical Coding Audit
Coding audits for every record type, including inpatient, outpatient, profee, and home health.
Medical Billing Audit
Billing audits across every claim type — Medicare, Medicaid, commercial, and self-pay.
Government & Payor Mandated Audit
Preparation for and response to TPE, RAC, OIG, DMEPOS, and Medical Necessity audits.
Clinical Audits
Internal and external clinical audits assessing the quality and safety of patient care and outcomes.
Collection Aging Audit
Improve cash flow by auditing aged claims for errors and refiling denied claims.
Medicare Chart Auditing
Auditing Medicare patient charts, ensuring every dollar billed is justified and compliant.
Chart Reviews & Data Validation
Medical Chart Reviews
Inpatient, outpatient, radiology, DME, and mammography chart reviews assessing care quality, coding compliance, and adherence to clinical guidelines.
Risk Adjustment Data Validation
Verifying the accuracy of diagnosis codes, HCCs, and risk scores to optimize reimbursement and avoid penalties.
Data Abstraction Review
Extracting and verifying diagnoses, procedures, medications, and lab results for accurate EHR data entry.
Our Revenue Cycle Audit Process
A structured, repeatable methodology — not a one-time scan — so your practice stays clean long after the first audit.
Identify Issues
We start by identifying the coding, billing, and documentation issues putting your revenue at risk.
Obtain Standards
Findings are measured against current payer rules, CMS guidelines, and industry benchmarks.
Collect Data
Auditors pull the full claim and chart history needed to evaluate every flagged encounter.
Compare Performance
We compare your actual billing performance against the standard to quantify the gap.
Implement Change
Corrective actions — recoding, refiling, workflow fixes — are rolled out across your practice.
Re-Audit
We re-audit on a set schedule to confirm the fixes held and catch anything new before it compounds.
We Work Within The Software You Already Use
No need to switch systems — our billing team plugs directly into the EHR and practice management platform you're already running.
Up to 30%
Revenue Recovered Through Auditing6
Core Audit Types Covered100%
Chart-Level Documentation ReviewFrequently Asked Questions
It's a systematic review of your claims and coding documentation to confirm compliance with payer rules, identify errors, and recover missed revenue.
We recommend a full audit annually, with quarterly spot-checks for high-volume or high-risk specialties.
We document every finding, prioritize by risk, and provide a corrective action plan — including refiling denied or underpaid claims where possible.
Yes. We prepare documentation for and respond directly to TPE, RAC, OIG, DMEPOS, and Medical Necessity audits on your behalf.
Yes. Auditing aged and denied claims often uncovers refilable revenue — clients typically see up to a 30% revenue increase after correcting audit findings.
No. Audits run in parallel with your existing billing workflow using secure, read-only access to charts and claims data.
Request Your Free Billing Quote
Tell us about your practice and one of our billing specialists will follow up within one business day.
CoreStone Medical Billing Services
Serving healthcare providers across all 50 states with accurate, compliant, and technology-enabled medical billing.