Most billing audits hand you a 40-page PDF and walk away. Ours find the leakage, recover the dollars, and rebuild the workflows that caused the leakage in the first place. As a full revenue cycle management company, we run your medical billing audit services as part of an active billing operation. You see findings, recovery, and prevention inside one engagement. CPMA-certified auditors. HIPAA-compliant by design.
Here’s the difference. Most audit firms can identify the leakage. They can’t recover it. We do both because the team that finds the dollars is the team that works the appeals, resubmits the corrected claims, and chases the payer underpayments until the money lands in your account.
Most audit firms hand you a PDF and walk away from your practice. We track every finding through to collected revenue, appeal status, or documented write-off. You see exactly which findings turned into dollars in your account.
Our auditors hold AAPC's Certified Professional Medical Auditor credential. Most audit firms claim "certified coders." That isn't the same thing. CPMA is the audit-specific certification, and every audit at our firm is supervised by one.
Pain management faces different OIG scrutiny than dermatology. Cardiology has different E/M audit triggers than primary care. We audit what actually matters for your specialty's risk profile, not a generic checklist that misses what matters.
Most audit reports show error counts and percentages. Useful, but incomplete. Our reports show error counts, percentages, and the dollar value of each finding category, so leadership can prioritize what matters financially first.
When a RAC, MAC, ZPIC, or commercial payer audit letter arrives, we respond within 4 hours during business days and have audit defense documentation underway within 5 business days. Most response deadlines run 30 to 45 days.
Revenue Recovery: Uncover undercoded services, missed charges, payer underpayments, and denied claims that should have been appealed. Most practices have 5 to 12% of annual revenue sitting in recoverable categories without realizing it. As a full revenue cycle company, we don’t just identify the recovery opportunity. We work the appeals, resubmit corrected claims, and chase payer underpayments until the dollars hit your account.
Compliance and Risk Mitigation: Identify documentation deficiencies, coding errors, and billing patterns that expose your practice to OIG audits, RAC recoupments, and payer recovery actions. Our audits review your billing against HIPAA, False Claims Act, Stark Law, Anti-Kickback Statute, and payer-specific requirements. You learn where your risk is before an external auditor or whistleblower finds it. The window between knowing and getting caught is everything.
Process Improvement: Analyze denial trends, intake workflows, coding patterns, and authorization processes to fix the root causes of revenue leakage. Generic auditors stop at findings. We rebuild the front-end RCM workflows that caused the findings in the first place. So your next audit doesn’t surface the same problems. This is where one-time audits become ongoing audit-readiness, which is what compliance teams actually want.
Examines patient charts for ICD-10 and CPT coding accuracy, confirms medical necessity documentation supports billed services, and identifies upcoding, unbundling, modifier misuse, and E/M errors. Most useful for practices with high denial rates or recent coding staff changes.
Reviews billing practices against HIPAA, OIG, False Claims Act, Stark Law, and payer-specific requirements to identify regulatory risk before external auditors find it. Most useful for practices with new payer contracts, ownership changes, or upcoming external audit notifications.
Analyzes denial patterns across payers, identifies root cause categories, and produces a denial prevention plan tied to your payer mix. Most useful for practices with denial rates above 5% or growing accounts receivable balances aging past 60 days.
Provides documentation production, response strategy, and appeals support when CMS contractors initiate audits against your practice. Most useful when you've received a RAC letter, MAC documentation request, ZPIC inquiry, or commercial payer recoupment notice this month.
Reviews encounter documentation against billed charges to identify missed services, undercoded procedures, and revenue leakage from incomplete charge capture. Most useful for hospital-based specialties, surgical practices, and multi-provider groups managing high-volume daily encounters across providers.
Reviews evaluation and management codes for accuracy, documentation support, and compliance with current AMA guidelines and 2021 E/M coding rules. Most useful for primary care, internal medicine, and any specialty billing high E/M volume daily.
Reviews claims before submission to prevent denials, rejections, and compliance violations from ever reaching payers. Most useful for new providers, post-credentialing periods, practices recovering from compliance issues, or specialties with high pre-submission error rates historically.
Reviews previously paid claims to identify underpayments, missed appeals opportunities, and recovery potential within timely filing windows. Most useful for practices with concerns about historical payer underpayments or contract terms not being honored across recent quarters.
Whether you’ve received a payer letter today or you’re planning ahead for next quarter, we’ll tell you which audit fits in 30 minutes.
Don’t see your specialty above? We’ve audited nearly every healthcare provider type imaginable. Tell us about your practice for a custom audit plan.
Most providers don’t think about external audits until they receive a payer letter. By then, the documentation gaps and coding errors have already happened. Our medical billing audit services include audit defense and pre-audit hardening for every type of CMS contractor audit your practice may face today.
Focus on identifying improper payments to providers. Compensation-based contractors paid a percentage of overpayments recovered. Most common audit type across all CMS regions. Risk areas include high-dollar claims, complex coding, and unusual billing patterns inconsistent with peer providers.
Process Medicare claims and conduct routine audits. Detect billing patterns inconsistent with peer providers. Risk areas include CERT-flagged providers, high E/M volumes, modifier overuse, and unusual claim frequency patterns flagged through CMS data analytics review systems daily.
Target suspected fraud, not random sampling. On-site inspections are common during ZPIC review. Risk areas include whistleblower tips, data analytics anomalies, referral patterns from MAC findings, and outlier billing volumes compared to specialty peer averages reported regionally.
Evaluate MAC processing accuracy through provider sampling. Document requests sent to randomly selected providers across regions. Failure to respond triggers automatic escalation. Risk areas include incomplete documentation responses, pattern errors across claims, and missed response deadlines.
Three-round audit-and-education cycles for providers flagged with high error rates by MACs. Designed as corrective rather than punitive enforcement. Risk areas include providers flagged for repeated denials, modifier issues, or documentation patterns inconsistent with Medicare guidelines.
Stop running audits that end with PDFs. Start running audits that end with collected dollars in your account. One O Seven RCM is the only medical billing audit firm built inside a full revenue cycle management company. We find your revenue leaks. We recover the dollars. We rebuild the workflows that caused the leakage. Find. Recover. Prevent. All under one engagement, with one team accountable for outcomes.
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