Medical Billing Audits and Assessments
A billing audit is a structured look at how a practice’s claims, coding, accounts receivable and credentialing actually run. This page lists the four reviews ClaimCarePro offers, what each one looks at, and where to start. The free A/R audit and the billing health check are the quickest ways in. We describe the process here, not outcomes.
Free A/R audit
A review of your open insurance receivables: which balances are real, which are past a payer deadline, and which are still worth working.
Billing health check
A short self-check on the basics of your billing operation, so you know where to look first.
Coding and compliance review
A sample of charts compared with the codes billed: code selection, modifiers, NCCI edits and documentation support.
Credentialing gap review
A check of which providers are enrolled with which payers, and whether an effective date is in writing before claims go out.
What an audit looks at
Every review follows the same order: the claim as submitted, the payer’s response, the posting of that response, and the follow-up that did or did not happen. We look at denial reasons and their codes, timely-filing deadlines, underpayments against the contracted rate, patient-balance handling, and the effective date behind each provider and payer. Findings are ranked by deadline and dollar value.