Medical billing audit companies review your claims, codes, and clinical documentation to find billing errors before a payer does. The good ones check CPT, HCPCS, ICD-10-CM, and modifier use against the chart, then help you fix denials, recover underpayments, and lower your audit risk.
Medicare’s fee-for-service improper payment rate was 6.55% in fiscal 2025, or $28.83 billion, according to CMS. Insufficient documentation drove 53% of those errors. Most of that money traces back to notes that didn’t support the claim, which is a problem a good audit catches early.
Our top medical billing audit companies for 2027 are One O Seven RCM, Healthicity (now part of Compliancy Group), DoctorsManagement, Fortis Medical Billing, and AAPC Audit Services. One O Seven RCM takes the top spot because one team runs the audit, works the recovery, and fixes the workflow behind each error.
Disclosure: One O Seven RCM publishes this list, sells medical billing audit services, and ranks itself first. We rated all ten companies, including ourselves, on the same seven weighted criteria and checked each claim against the company’s own website on October 28, 2026.
Best Medical Billing Audit Companies Compared at a Glance
The table below compares ten medical billing auditing companies by what each one does best, what it audits, who it serves, and whether it publishes pricing. You’ll find a full review of each company in the next section.
| Company | Best for | Main audit focus | Who it serves | Pricing shown |
| One O Seven RCM | Practices that want findings recovered and fixed by one team | Coding, compliance, denials, charge capture, E/M, prepayment and post-payment, RAC, MAC, UPIC, and TPE defense | Practices, groups, hospitals | Audit price ranges published; free scope call; billing from 3% |
| Healthicity | Compliance teams that want audits and software | Coding and documentation, risk adjustment, special investigations, outpatient CDI | Hospitals and health systems | Not published; underpayment recovery at no upfront cost |
| DoctorsManagement | Chart audits tied to provider training | Chart and coding audits, 10 to 30 records per provider | Physician practices | Custom proposal |
| Fortis Medical Billing | Compliance and fraud-risk reviews | Coding, billing, ASC, dental, hospital, radiology, HCC | Practices, ASCs, hospitals | Free compliance audit offered |
| AAPC Audit Services | Audits from the coding credentialing body | Chart reviews, HCC audits, CDI, AI coding tool support | Providers and healthcare organizations | Not published |
| R1 RCM (Phare Audit) | Large health systems that want pre-bill review | Pre-bill coding, DRG, and documentation review | Health systems | Not published |
| VMG Health | Health systems, ASCs, and eyecare groups | Professional and facility coding and documentation | Health systems, ASCs, MSOs | Not published |
| CureMD | Audits paired with staff training | CPT, ICD-10, and modifier review from charge capture to denials | Physician practices | Limited-time free audit offered |
| MDaudit (software) | Ongoing audit monitoring | Audit workflows, billing and denial risk analytics, payer audit management | Health systems, physician networks, hospitals, ASCs | Not published |
| BillingMate | Turning findings into an action plan | Claims, coding, documentation, payments, denials, A/R | Physician practices | Not published |
Details checked on each company’s website on October 28, 2026.
How We Ranked the Best Medical Billing Audit Companies
Before a medical billing audit begins, the medical billing audit company you hire will see your charts, your codes, and your payer mix. That access should come with proof of skill, clear pricing, and help after the report lands. We scored each company on seven criteria, weighted by how much each one moves your revenue and risk.
Our Seven Scoring Criteria
Each criterion below matches a question practice owners ask when they compare auditors, from accuracy and pricing to how fast a company answers the phone. The heaviest weights sit on scope and credentials, because those two decide whether the findings hold up.
| Criterion | Weight | What we checked | Buyer question it answers |
| Audit scope | 20% | Which audit types the company performs, and whether it reports both overbilling and underbilling | Quality |
| Auditor credentials and accuracy | 20% | Named auditors and credentials such as AAPC’s CPMA credential, CPC, or AHIMA’s CCS, plus stated accuracy methods | Accuracy |
| Fixing what the audit finds | 15% | Whether findings come with corrective action, appeals, and recovery, or stop at a report | Reliability |
| Payer audit defense | 15% | Support for RAC, MAC, UPIC, TPE, and commercial payer audits, including appeals of automated E/M downcoding | Reliability |
| Pricing transparency | 10% | Whether the company publishes price ranges or its pricing model | Pricing |
| Responsiveness | 10% | Stated turnaround times and response commitments | Customer service, timeliness |
| Trust and compliance | 10% | BAA, HIPAA, SOC 2, and public client proof such as case studies | Trustworthiness |
We rated each company on these criteria using what it publishes, and the weights set the order of the top 10 below.
Strong medical billing audits report overbilling and underbilling side by side. An audit that hunts only underpayments misses the findings that protect you in a payer audit, and one that hunts only compliance risk leaves earned revenue unbilled. MDaudit is the one coding audit vendor here that sells software alone, so it carries a “software” label in the table.
How We Verified Each Company
- We checked each company’s claims on its own website on October 28, 2026, and each review attributes those claims to the company that made them.
- No company paid to appear on this list, and the page carries no affiliate links.
- We left out healthcare auditing companies that audit providers on behalf of payers, plus EHR vendors with no separate audit service. Medical coding audit companies made the list only if they audit for providers.
- We scored One O Seven RCM by the same rules, and [Reviewer name, credential] reviewed the scoring. Our third-party billing company rankings use the same approach.
- We re-check each company monthly and change the updated date when a detail changes.
Medical Billing Audit Companies Reviewed: Our 2027 Top 10
The companies below range from coding specialists and compliance firms to full revenue cycle companies and one software platform. Some sell medical billing review services alongside full billing. Each review covers what the company audits, who it suits, and what it charges when it says.
1. One O Seven RCM
One O Seven RCM runs coding, compliance, denial, charge capture, and E/M audits for U.S. practices and hospitals, then works the recovery itself as a full revenue cycle company. The team that finds a denied or underpaid claim also appeals it, collects it, and fixes the workflow that caused it.
What One O Seven RCM audits
- Coding and E/M audits checked against the chart across your high-volume CPT codes
- Compliance audits, plus prepayment and post-payment reviews
- Denial and charge capture audits that trace lost revenue back to its source
- RAC, MAC, UPIC, CERT, and TPE audit defense when a payer letter arrives
How an audit runs
Our medical billing audit services review 10 to 30 records per provider. Most audits launch within 14 days of signing and take four to six weeks from scope to final report. Focused audits finish in two to three weeks, and hospital or multi-specialty audits take eight to 12.
- Scope definition and sample selection
- Documentation and coding review
- Findings report and recovery plan
- Active recovery and appeals
- Process fixes and ongoing monitoring
Recovery and process fixes continue for 60 to 120 days after the report, with the same team working each appeal.
Results practices have seen
In our pediatric practice case study, a certified coding expert audited 90 days of denied and underpaid claims for a Washington pediatric practice. After the audit and the billing cleanup that followed, average AR days fell from 63 to 28, denials dropped 76%, and monthly revenue grew from $4,000 to $35,000 within six months.
Team and security
The team holds AAPC CPMA and CPC, AHIMA CCS, and HFMA CRCR credentials and covers more than 75 specialties. Each engagement runs under HIPAA and SOC 2 Type II controls, with a signed BAA included.
Pricing
- Free 30-minute scope consultation, then a written proposal with timeline and pricing within a week
- Focused audits for small practices: low four figures
- Full audits for multi-provider groups: mid four figures into the low five figures
- Billing after the audit: 3% of monthly collections, no setup fee, no long-term contract, solo practices from 2.99%
- Credentialing: from $107 per payer, CAQH setup included
Best for: Practices that want audit findings recovered and fixed by the same team that found them.
Details verified on oneosevenrcm.com on October 28, 2026.
Want to see what an audit would turn up in your own claims? Book your free scope call, and you’ll have a written proposal with timeline and pricing within a week.
2. Healthicity
Healthicity, part of Compliancy Group since June 17, 2026, provides coding and documentation audits, risk adjustment audits, and special investigations support for hospitals and health systems. Its auditing software now runs as Audit Manager+ by Compliancy Group.
Best for: Compliance teams that want audits and software from one vendor.
Audit types: Coding and documentation, E/M, risk adjustment, special investigations, outpatient CDI, underpayment recovery.
Pricing: Not published.
Worth knowing: Billing-side work such as A/R follow-up and payment posting isn’t featured.
Details verified on Healthicity’s website on October 28, 2026.
3. DoctorsManagement
DoctorsManagement provides chart audits and coding reviews for physician practices, pairing its medical billing and coding audit services with a feedback and training session for providers.
Best for: Practices that want external coding audits tied to provider education.
Audit types: Chart audits, coding reviews, provider training.
Pricing: Custom proposal.
Worth knowing: The site quotes two different accuracy figures, 98% and 95%.
Details verified on DoctorsManagement’s website on October 28, 2026.
4. Fortis Medical Billing
Fortis Medical Billing runs coding, billing, ASC, dental, hospital, radiology, and HCC audits for practices and facilities, and it says former federal investigators work on its audit team.
Best for: Practices worried about fraud-risk findings.
Pricing: Free compliance audit offered. Full audit pricing isn’t published.
Worth knowing: The coding audit page names no specific certifications such as CPC or CCS.
Details verified on Fortis Medical Billing’s website on October 28, 2026.
5. AAPC Audit Services
AAPC Audit Services runs prospective and retrospective chart reviews, risk adjustment (HCC) audits, and AI coding tool support, backed by the credentialing body behind the CPC and CPMA.
Best for: Organizations that want audits from the coding credentialing body.
Pricing: Not published.
Worth knowing: Recovery work and payer appeals aren’t listed among its audit services.
Details verified on AAPC’s website on October 28, 2026.
6. R1 RCM
R1 RCM offers Phare Audit, a pre-bill revenue integrity audit that pairs an AI engine with R1’s coding and DRG experts, a form of external coding review for large hospitals and health systems.
Best for: Large health systems.
Pricing: Not published.
Worth knowing: Phare Audit works before billing, so it won’t defend a payer audit that’s already underway.
Details verified on R1 RCM’s website on October 28, 2026.
7. VMG Health
VMG Health runs professional and facility coding and documentation audits for health systems, ASCs, and eyecare groups, backed by a tool that simulates OIG audit processes.
Best for: Health systems, ASCs, and eyecare platforms.
Pricing: Not published.
Worth knowing: Among healthcare audit firms, VMG Health leans toward valuation and advisory, and its medical coding audit services center on large systems and facilities.
Details verified on VMG Health’s website on October 28, 2026.
8. CureMD
CureMD audits CPT, ICD-10, and modifier use for physician practices from charge capture to denial management, and it pairs each audit with staff training.
Best for: Practices using, or weighing, CureMD’s EHR and billing platform.
Pricing: Limited-time free audit offered.
Worth knowing: CureMD also sells EHR and billing software, so expect a wider sales pitch.
Details verified on CureMD’s website on October 28, 2026.
9. MDaudit
MDaudit is a cloud-based audit and billing risk platform for hospitals, health systems, physician networks, and ASCs, covering scheduled, risk-based, denial, and coding quality audits.
Best for: Health systems that want continuous audit monitoring software.
Pricing: Not published.
Worth knowing: MDaudit is software, so your own auditors or an outside firm still review and act on what it flags. It added pre-bill charge and coding review when it acquired Streamline Health in August 2025.
Details verified on MDaudit’s website on October 28, 2026.
10. BillingMate
BillingMate reviews claims, coding, documentation, payments, denials, and A/R for physician practices, and like several medical claims auditing firms, it delivers each report as a practical roadmap.
Best for: Practices that want a fix-it plan.
Pricing: Not published.
Worth knowing: The audit page doesn’t name auditors or list their credentials.
Details verified on BillingMate’s website on October 28, 2026.
How to Narrow the List
The right medical billing audit companies for a solo practice aren’t the ones a health system needs. If you want one medical billing audit company to find the errors, recover the money, and keep the fixes in place, One O Seven RCM is built for that work.
Get your free audit scope today, and our team will tell you which codes, payers, and providers we’d audit first, with a written proposal inside a week.
Why Practices Hire a Medical Billing Audit Company in 2027
Practices hire a medical billing audit company to find the documentation and coding errors a payer would find, before the payer finds them. An outside reviewer also spots patterns your own team stops seeing, such as one provider who bills 99214 for most follow-ups or a modifier that rides on half the claims.
Medicare’s fee-for-service improper payment rate was 6.55% in fiscal 2025, or $28.83 billion, down from 7.66% a year earlier, according to the CMS FY2025 improper payments fact sheet. Part B, which includes physician services, ran higher at 8.44%. Catching those errors first is the core job of medical billing audit companies.
The CMS supplemental improper payment data breaks the errors down. Insufficient documentation drove 53.0% of improper payments, medical necessity 15.3%, no documentation 12.0%, and incorrect coding 11.1%. A visit can be real and still count as improper. Picture a 99214 billed on a note that supports only low-complexity decision-making.
Medicare Advantage carries the same risk. CMS reported a 6.09% Part C improper payment rate, or $23.67 billion, for fiscal 2025, up from 5.61% the year before. OIG’s current work plan, covered in the specialty section below, shows which services federal auditors are checking this year.
Federal review is set to grow in 2027. HHS’s program integrity plan for fiscal years 2026 and 2027 calls for more complex medical reviews by Medicare Recovery Audit Contractors and new automated fraud detection edits across Medicare and Medicaid claims. Commercial payers are moving the same way, with automated reviews of level 4 and 5 E/M claims.
A medical billing audit is the cheapest point to find a problem, because you set the sample, the timeline, and the fixes. Once a payer sends a records request, those choices pass to the auditor on the other side of the table.
Types of Medical Billing Audits
In medical billing, the four main audit types are coding and documentation audits, billing and claims audits, compliance audits, and payer or government audits. Each one can run before claims go out, called a prospective audit, or after payment, called a retrospective audit. Most medical billing audit companies run some mix of all four.
Inside those four groups sit seven specific audits you’ll see on a proposal:
- Coding and documentation audits check CPT, HCPCS, and ICD-10-CM codes and modifiers against the chart, including E/M levels, and a medical coding audit often turns up CPT 99213 underbilling patterns.
- Billing and claims audits follow each claim from charge entry to payment, so a medical claims audit catches missed charges, posting errors, and underpayments.
- Denial audits sort denials by payer and reason code, so your claim denial management fixes the cause instead of appealing the same error each month.
- Risk adjustment (HCC) audits are a medical documentation audit that confirms the chart supports each diagnosis reported for Medicare Advantage patients.
- Compliance audits test your claims against OIG guidance, payer policy, and the 60-day overpayment rule, and a billing compliance audit sits at the center of most coding and compliance audits.
- Payer audit defense gets your records and responses ready when a RAC, MAC, UPIC, or commercial payer asks for charts.
- Prospective and retrospective audits differ by timing: prospective audits review claims before they go out, and retrospective audits review claims already paid.
Your own coders or compliance staff run internal audits, and outside medical billing audit companies or payers run external ones. An outside reviewer catches habits your team has stopped questioning, like a default E/M level or a copied-forward note. Medical coding audit services from an independent firm also carry more weight if a payer later questions how you police your billing.
A good audit reports overbilling and underbilling. Undercoding feels like the safe mistake, yet it gives away earned revenue, and a steady run of low codes can draw payer attention on its own. Our guide to downcoding risks covers that pattern, and good medical billing audit services score both directions.
Medicare Audits vs Commercial Payer Audits
Medicare audits follow CMS rules, and commercial payer audits follow your contract. Recovery Audit Contractors (RACs) review paid claims up to three years from the date Medicare paid them under the CMS Recovery Audit Program. MACs run CMS Targeted Probe and Educate reviews, and UPICs investigate suspected fraud across Medicare and Medicaid.
Commercial payers set their own look-back periods, appeal rights, and recoupment terms, and those terms live in the provider agreement you signed. Pull the contract before you answer a commercial audit letter, since a payer’s request may reach back further than you expect.
Several commercial plans now review E/M levels with algorithms. Cigna’s policy covers level 4 and 5 office and consultation codes such as 99214 and 99215, and Aetna expanded its claim and code review program to every commercial state except Louisiana. Maryland fined Cigna $80,000 and ordered it to stop automatic downcoding. An audit of your E/M level distribution gives you the documentation to appeal a downcoded claim.
Who Audits Hospital Billing?
Three groups audit hospital billing: your own team, Medicare’s contractors, and commercial payers.
- Internal reviewers: Compliance and coding staff, plus independent medical billing audit companies hired for a second look.
- Medicare contractors: MACs handle medical review and TPE under their MAC billing guidelines, RACs run post-payment review, UPICs look into suspected fraud, CERT contractors pull random samples to measure the national error rate, and HHS-OIG audits targeted risk areas.
- Commercial payers: Each payer reviews claims under its contract, and many hire medical claim audit companies to do the work for them.
Since September 1, 2025, MACs handle the short-stay inpatient reviews that BFCC-QIOs used to perform, so your MAC now sees those claims as well.
How Long You Have to Respond
Most Medicare record requests give you 45 days to respond, and UPIC requests give you 30.
- 45 days for an additional documentation request from a MAC, RAC, or SMRC, per CMS additional documentation requests guidance.
- 30 days for a UPIC request, with a good-cause exception.
- At least 45 days between TPE rounds, with 20 to 40 claims per round and up to three rounds. After three failed rounds, CMS may move you to 100% prepayment review, extrapolation, or a RAC referral.
Log the request date the day the letter arrives, and send what the request lists. Any late entry or addendum has to follow CMS’s rules for amending records, so talk to your auditor before anyone touches a signed note.
What Happens If an Audit Finds an Overpayment
Once you’ve identified an overpayment, the rule at 42 CFR 401.305 gives you 60 days to report and return it. Since January 1, 2025, “identified” follows the False Claims Act knowledge standard, which covers knowing receipt, reckless disregard, and deliberate ignorance.
You can pause the 60-day clock for up to 180 days while you run a timely, good-faith investigation into related overpayments. CMS set its interest rate on Medicare overpayment debts at 11.875%, effective October 21, 2026, and it resets that rate each quarter, so check the current rate before you calculate a refund. An internal audit that finds a pattern needs follow-through, so bring in healthcare counsel before you decide what to report.
Medical billing audit companies that offer payer audit defense, sometimes sold as payor audit services, build the response package, track each deadline, and handle appeals. Our RAC and TPE audit defense work covers RAC audit defense, MAC reviews, and commercial payer requests.
If a records request landed on your desk this week, call One O Seven RCM before anything goes back to the payer. We’ll review the request with you, confirm the deadline, and start building the response package.
What Changes for Medical Billing Audits in 2027
Medical billing audits in 2027 will test claims against a new CPT code set, a revised Medicare fee schedule, and more review from Medicare contractors and commercial payers. HHS’s program integrity plan for fiscal years 2026 and 2027 calls for more complex medical reviews by Recovery Audit Contractors and new automated fraud detection edits.
- January 1, 2027: CPT 2027 takes effect with 299 new codes, 74 revisions, and 80 deletions, including a maternity care framework that replaces the global maternity bundle, according to the AMA.
- January 1, 2027, if finalized:CMS proposed paying the highest-valued same-day service at 100% and other eligible same-day services, including an E/M visit billed with modifier 25, at 50%. It also proposed turning G2211 into a modifier worth 16% of the E/M payment.
- January 1, 2027: Medicare Advantage plans, Medicaid and CHIP programs, and federal exchange plans must offer a Prior Authorization API under CMS-0057-F, on top of the specific denial reasons they’ve owed since January 1, 2026.
- Through 2027: Commercial payers, including Cigna and Aetna, keep using automated reviews of level 4 and 5 E/M claims, while states such as Maryland push back.
- Pending: CMS’s CRUSH anti-fraud proposed rule, a Fifth Circuit ruling on the Medicare Advantage RADV rule, and a final HIPAA Security Rule that HHS now targets for July 2027.
Ask any company on this list how it will test your 2027 code updates, your modifier 25 claims, and your level 4 and 5 E/M visits. Those three areas carry the most new risk in 2027.
Medical Billing Audits by Specialty and Practice Size
Your specialty decides where an audit should dig, and your size decides how big the sample needs to be. Most medical billing audit companies will ask for both, plus your top CPT codes by volume, before they send a quote.
Specialty Risk Areas for 2027
OIG’s active audits and CMS’s 2027 payment changes show where reviewers are looking, and the table maps each one to the practices it touches.
| Specialty or service | What the audit should check | Why now |
| Primary care, dermatology, orthopedics | E/M levels and modifier 25 on minor-procedure days | OIG is reviewing E/M services billed on the same day as minor surgery without modifier 25 (OAS-26-04-028, announced March 16, 2026); CMS has also proposed paying lower-valued same-day services, including modifier 25 E/M visits, at 50% for 2027 |
| Practices billing chronic care management | CPT 99490 time logs (first 20 minutes of clinical staff time per calendar month) and two or more qualifying chronic conditions | OIG opened an audit of chronic care management payments at risk of noncompliance (OAS-26-09-007, March 16, 2026) |
| Wound care | Skin substitute claims and supporting documentation | OIG has an active audit of Part B skin substitute payments (OAS-25-09-005) |
| Practices with Medicare Advantage patients | Chart support for each HCC diagnosis | OIG’s Priority Health audit found records didn’t support diagnosis codes for 252 of 300 sampled enrollee-years (A-07-22-01208, March 31, 2026); OIG’s February 3, 2026, Medicare Advantage compliance guidance also flags AI-generated EHR prompts that add unsupported diagnoses |
| Home health | Claims billed with an institutional admission source | OIG announced a nationwide compliance audit on April 23, 2026 (OAS-26-05-056) |
| Behavioral health | Time-based psychotherapy codes and documented session time | General coding risk; no specific OIG item |
| Practices billing RPM or RTM | The initiating visit and who performs the monitoring | CMS proposed requiring a separately reportable initiating visit and paying only when practice-employed clinical staff do the work, starting in 2027 |
| OB/GYN | Maternity claims under the new CPT 2027 framework | CPT 2027 replaces the global maternity bundle on January 1, 2027 |
| Practices in WISeR states (Arizona, New Jersey, Ohio, Oklahoma, Texas, Washington) | A prior authorization decision or prepayment review record for each selected service | CMS’s WISeR model runs through December 31, 2031 |
An E/M coding audit is the first audit most primary care practices need, and modifier 25 sits at the center of it. Our guide to modifier 25 billing rules covers the separate documentation a same-day visit needs before you bill both services.
Behavioral health audits center on time, since the note has to show the minutes behind each psychotherapy code. In our psychiatric billing audit example, a Texas practice moved from $1,800 to $3,000 in monthly collections to a $3,500 to $6,000 range after the billing cleanup.
Audits work best when the auditor already knows a specialty’s payer rules. Our specialty medical billing services cover more than 75 specialties, so the same coders who audit your charts know your payers’ edits.
Small Practices, Groups, and Hospitals
Small practices and solo providers tend to find their patterns in a focused baseline audit of 10 to 30 records per provider. Repeat it once a year, or sooner when you add a provider, switch EHRs, or see denials climb. If billing needs outside help afterward, our billing for small practices starts at 2.99% of collections for solo providers.
Groups should compare E/M level distribution across providers in the same specialty. Payer analytics flag outliers first, so a provider billing 99215 at twice the rate of colleagues needs a chart review before a payer asks. The same comparison shows who is undercoding and leaving earned revenue behind.
Hospitals need DRG validation on inpatient claims, pre-bill chart review for MS-DRG accuracy, and charge capture and chargemaster reviews on the outpatient side. A healthcare coding and compliance audit should also test readiness for RAC and MAC reviews, the work our hospital revenue cycle management team runs.
One-Time Audit vs Ongoing Audit Software
A one-time medical billing audit service is a fixed-scope review in which certified auditors pull a sample, score accuracy, and hand you a findings report with fixes. Ongoing audit software, such as MDaudit, watches claims on a rolling basis and flags risky patterns as they appear. Most practices start with a baseline audit, then decide how much monitoring they need.
| One-time audit | Ongoing audit software | Ongoing monitoring by a billing partner | |
| What you get | Findings report on a sample | Risk flags as claims flow | Monthly review built into billing |
| Who acts on findings | Your team, or the auditor if remediation is included | Your team | The billing partner |
| Best for | A baseline, a payer letter, or a new provider | Health systems with internal audit staff | Practices without in-house coders or auditors |
Software flags problems, and your staff still fixes them, so it suits teams with auditors on payroll. Smaller practices tend to get more from a baseline audit followed by a revenue cycle audit built into monthly billing, the model behind our end-to-end revenue cycle management. Ask any of the medical billing audit companies above whether monitoring continues after the report.
How Much Does a Medical Billing Audit Cost?
Medical billing audit cost has no industry standard, because auditors price per chart, per provider, or as a flat project. Your total rises with the number of charts, your specialty, and whether recovery and appeals come with the audit. Hospital audits scale with the number of service lines and claims in scope.
At One O Seven RCM, focused audits for small practices tend to run in the low four figures, and a comprehensive medical billing audit for a multi-provider group runs from the mid four figures into the low five figures. Each engagement starts with a free 30-minute scope consultation and a written proposal.
| Pricing model | How it works | What to watch |
| Per chart | A set fee for each record reviewed | Confirm the sample size before you sign |
| Per provider | A fee for each provider’s sample | Good for groups; check whether some specialties cost more |
| Flat project | One price for a defined scope | Get the scope in writing, including the report and any re-audit |
| Retainer | A monthly fee for ongoing reviews | Works when you want quarterly sampling |
| Contingency | A percentage of money recovered | See the warning below |
Medical billing audit companies that work on contingency get paid only on dollars they recover, which gives them little reason to flag overbilling. Overbilling is the finding that protects you in a payer audit. If you choose contingency pricing, ask the company to explain in writing how it reports the overpayments it finds.
Audits often point to fixes outside coding. If denials trace back to enrollment gaps, our provider credentialing services start at $107 per payer with CAQH setup included. Full billing runs at 3% of monthly collections, with no setup fee and no long-term contract.
Get a quote built on your own claim volume and specialty. Our billing audit pricing starts with a free 30-minute scope call, and our medical billing audit services come with a written proposal, timeline included, within a week.
How to Choose a Medical Billing Audit Company
Choose on three things: who reviews your charts, whether the company fixes what it finds, and whether its process matches what OIG expects. OIG’s General Compliance Program Guidance lists risk assessment, auditing, and monitoring as one element of an effective compliance program, and strong medical billing audit companies build their process around it.
Credentials to Ask For, and Why You Don’t Need a CPA
No. A CPA signs off on financial statement audits, and medical billing audits fall outside that work. Certified coders and auditors run billing and coding audits, and most hold AAPC’s Certified Professional Medical Auditor (CPMA) or Certified Professional Coder (CPC) credential, or AHIMA’s Certified Coding Specialist (CCS).
Ask for the name and credentials of the medical billing auditor who’ll review your charts. A line on a website saying the team is certified tells you nothing about the person who opens your records, and a good company will share that name before you sign.
Questions to Ask Before You Sign
Bring these seven questions to each scope call and compare the answers side by side:
- How many charts per provider will you review, and how do you pick them?
- Who reviews them, and what credentials do they hold?
- Do you report underbilling as well as overbilling?
- Can I see a redacted sample report?
- Do you fix what you find, including appeals and recovery, or only report it?
- Will you sign a BAA, and how do you protect our data?
- Are you independent of the company that does our billing?
A medical billing auditing company that answers all seven in writing, before you sign, is one you can hold to its word. One O Seven RCM puts the scope, timeline, and price in a written proposal within a week of your scope call.
Red Flags
Slow down if you see any of these during the sales process:
- A guaranteed recovery percentage before anyone has seen a chart
- Contingency-only pricing with no plan for reporting overpayments
- “Certified auditors” with no names behind the claim
- No sample report, or a report that lists errors without causes
- A findings report with no plan for appeals or recovery
Pre-Audit Checklist
Use this pre-audit list to gather what an auditor will ask for before your scope call, and our yearly medical billing audit checklist for the full review by payer:
- Your last 90 days of denials, grouped by reason code
- E/M level distribution by provider
- Payer contracts and fee schedules
- A sample of EOBs or ERAs
- Your current compliance policies
- A signed BAA with the audit company
KPIs a Medical Billing Audit Should Improve
Judge an audit by the numbers that move after it, so track these KPIs for three months before and after. Rework adds up: MGMA estimated in 2014 that reworking a denied claim cost about $25, as reported in AAFP’s Family Practice Management. That estimate is more than a decade old, so check it against your own staff time.
| KPI | How to calculate it | What a good audit should change |
| Clean claim rate | Claims accepted on first submission with no edits, divided by total claims submitted | Fewer front-end and coding errors reach the payer (see how to improve your clean claim rate) |
| Denial rate | Denied claims divided by total claims submitted | Fewer repeat denials for the same reason code |
| Days in A/R | Total accounts receivable divided by average daily charges | Faster payment once root causes are fixed, with AR follow-up services working the backlog |
| Net collection rate | Payments divided by charges minus contractual adjustments | More of what you’re owed reaches your account |
| Coding accuracy rate | Records coded without errors divided by records audited | Higher accuracy in the follow-up audit |
| Charge lag | Days from date of service to charge entry | Shorter lag after workflow fixes |
Run a follow-up audit on a fresh sample three to six months later. If the same errors show up, the fix didn’t reach the workflow, and the training or system edit needs another pass. The medical billing audit companies worth hiring will offer that re-audit and price it in the first proposal.
Medical Billing Audit FAQs
What is an audit in medical billing?
A medical billing audit is a review of a sample of claims against the chart, the codes, and the payer’s rules, to check whether each claim matched the documentation and was paid as the payer allows. Many auditors pull 10 to 30 records per provider and score accuracy for each one.
The review covers CPT and ICD-10-CM codes, modifiers, documentation, and payment. A good audit reports overbilling that creates payer risk and underbilling that leaves earned revenue behind, then explains the cause behind each error so your team can fix the workflow.
How often should a practice audit its billing?
No federal rule sets one audit schedule for each practice. OIG’s General Compliance Program Guidance treats auditing and monitoring as ongoing work driven by your own risk assessment. Most practices run a baseline audit first, then review a fresh sample at least once a year.
Audit sooner after you add a provider, change EHR systems, see denials jump, or receive a payer letter. High-risk services, such as chronic care management or same-day procedures billed with modifier 25, can justify a quarterly sample of their own.
Which medical billing audit company is best?
For most practices, One O Seven RCM is the strongest pick, because one team runs the audit, works the appeals, and fixes the workflow behind each error. Health systems that want software alone can look at MDaudit, and Medicare Advantage programs may want an HCC specialist.
Among the medical billing audit companies reviewed above, the “Best for” line in each entry points to the right fit. Compare two or three medical billing auditing companies on auditor credentials, sample size, and what happens after the findings report lands.
What denials does a billing audit usually uncover?
Audits tend to trace denials to five problems. Eligibility and coverage gaps show up as CO-27 and CO-31, missing claim information as CO-16, and missing prior authorization as CO-197. Medical necessity and diagnosis mismatches appear as CO-50 and CO-11, and bundling errors as CO-97.
The audit shows which denials repeat and with which payer, so you can fix the step that causes them. Our guide to the top denial codes walks through the fix for each one.
Who pays for the audit?
If your practice hires the audit, your practice pays for it. Government audits work another way: CMS pays RACs a contingency fee based on the improper payments they identify and correct, so a RAC review doesn’t come with an invoice to your practice.
Before you sign with a private auditor, ask whether the fee covers the follow-up re-audit, appeal support, and any extra charts. At One O Seven RCM, the scope consultation is free, and the written proposal states the price before any work begins.
How long does an audit take?
Most practice audits take about four to six weeks from scope to findings report, based on the timelines One O Seven RCM and DoctorsManagement publish. One O Seven RCM says smaller focused audits finish in two to three weeks, while hospital and multi-specialty group audits take eight to 12 weeks.
Recovery work runs longer, and One O Seven RCM puts remediation at 60 to 120 days after the audit. Your own timeline depends on chart access, sample size, and how fast your team answers auditor questions.
Is a medical billing audit the same as a coding audit?
A coding audit is one part of a medical billing audit. The coding audit checks whether CPT, HCPCS, and ICD-10-CM codes and modifiers match the documentation. A full billing audit follows the claim through charge entry, submission, payment posting, denials, and A/R, so it catches money lost after the code was right.
Practices with clean coding but slow cash tend to need the wider review. Ask which one a proposal covers, since companies use the two names for different scopes.
What changes for medical billing audits in 2027?
CPT 2027 takes effect on January 1, 2027, with 299 new codes, 74 revisions, and 80 deletions. CMS has also proposed paying lower-valued same-day services billed with modifier 25 at 50%, pending the final 2027 fee schedule. HHS plans more complex reviews by Recovery Audit Contractors, and commercial payers keep expanding automated E/M reviews, so a 2027 audit should test code updates, modifier 25, and E/M level support first.
Can AI coding tools lower your audit risk?
They can speed up review, but they don’t move the liability. OIG’s Medicare Advantage compliance guidance, released February 3, 2026, lists AI-generated EHR prompts that add unsupported diagnoses as a fraud and abuse risk. Each code still needs a signed note that supports it, so an audit should test AI-assisted claims the same way it tests any other claim.
How to Get Your First Audit Started
The fastest way to start is a small baseline audit on your highest-risk codes, scoped tight enough to finish in a few weeks. A full review of each service line can come later, once you know where the errors cluster.
- Pull your last 90 days of denials by reason code and your E/M distribution by provider.
- Pick the audit type that matches what you see: coding, denials, or payer audit readiness.
- Ask two or three medical billing audit companies from this list for a written scope and a sample report.
Ready for a second set of eyes on those numbers? Talk to our audit team. Our medical billing audit services start with a free 30-minute scope call, and we’ll show you what we’d audit first and what it costs before you commit to anything.
