Medical Billing Audit Services
Catch Revenue Leaks Before They Occur
Your practice’s financial success begins with having a clear picture of how you bill.
Billing errors, missing charges, and denied claims can quietly reduce your revenue. At Swiftcare Billing, our Medical Billing Audit Services provide a comprehensive analysis of your billing operations to uncover untapped revenue potential and ensure compliance with payers’ rules.
We help healthcare providers gain clarity and control over collection and enhance their financial success.Why Providers Trust Swiftcare Billing Audits
Audits at Swiftcare Billing go beyond mere checklists. They serve as a strategic resource that identifies areas where your revenue may have been lost, coding discrepancies, and inefficiencies in your workflow. Our Medical Billing Specialists use this information to help providers of all sizes take charge of their revenue cycle.
- Coding Review / CPT / ICD-10 / HCPCS : An evaluation of CPT, ICD-10 and HCPCS coding to verify correctness;
- Claims submission accuracy: verification that claims have been submitted with all necessary payer requirements
- Denial Trend Analysis: identifying why most of the denials occur to prevent future denials from occurring in a non-necessary manner.
- Accounts receivable analysis: examination of all outstanding accounts and delayed payments.
- Compliance reviews: verification of Medicare, Medicaid, and Commercial Payer compliance.
- Audit recommendations: actionable steps to increase revenue and create an improved workflow for your office.
The Swiftcare Billing Audit process
1
Initial consultation and goal setting
At this stage of the process, we will gather as much information as possible about the size and type of your practice, as well as the specific billing issues you currently encounter.
2
Data collection and analysis
We will gather claims data, payment histories, EHRs, and other records for every physician on your staff. We will then evaluate all collected data to identify any discrepancies or errors that could cause problems with claim submissions.
3
Coding & Charges Review
All services, procedures, and encounters are reviewed for proper utilization of CPT, ICD-10, and modifiers. Any missed charges are identified to prevent revenue loss from errors.
4
Claims Submission & Denial Review
The submitted claims are reviewed, along with the denial patterns, to determine whether there are common errors or payer-specific issues causing non-payment.
5
Accounts Receivable & Payment Posting Audit
The outstanding AR is audited, and the practice’s payment posting processes are reviewed for accuracy. Errors or delays in reconciliation are identified.
6
Compliance & Regulatory Review
Compliance with Medicare, Medicaid, and other commercial payer regulatory standards is evaluated during the review process. In addition, compliance with HIPAA regulations and documentation requirements is verified.
7
Reports & Implementation Support
Following the completion of an audit, a detailed report will be provided to the client, detailing the errors, opportunities, and steps the client can take to implement the recommendations to improve their workflow.
Medical Billing Audits Designed For Every Kind of Medical Practice
At SwiftCare Billing, we understand that every medical practice is different and therefore has its own set of unique billing issues. Our audits are tailored to address the specific requirements and challenges of each medical specialty:
- Primary Care & Family Practice: This type of audit focuses on the billing of preventive visits, E/M coding, and chronic care management claims.
- Internal Medicine: Procedural coding, diagnostic testing, and office visit billing are audited
- Surgical Practices: Operative notes, assistant surgeon charges, and CPT compliance are scrutinized
- Mental Health & Behavioral Health: Therapy session coding, telehealth claims, and authorization tracking are audited
- Physical Therapy & Rehabilitation: Time-based billing for services rendered, modifier usage, and validation of claims for insurance coverage
- Pain Management & Specialty Clinics: Complex procedures, injections, and claims for Durable Medical Equipment are reviewed
Revenue Cycle Performance Improvement
Convert audit findings into actionable revenue growth initiatives
At Swiftcare Billing, our audits do more than identify errors. We provide strategic guidance for the improvement of your practice’s revenue cycle:
At Swiftcare Billing, our audits do more than identify errors. We provide strategic guidance for the improvement of your practice’s revenue cycle:
- Identify under-billed and missed revenue opportunities
- Identify denial patterns and recommend corrective actions
- Improve the workflow for billing patients and posting payments
- Enhance communication among providers, coders, and payers
- Identify under-billed and missed revenue opportunities
- Compare your practice to industry benchmarks for financial performance
- Advanced Technology & Secure Audit Process
- Accurate audits utilizing technology and expert analysis
Swiftcare Billing will conduct an extensive audit using advanced billing software and analytical tools. A precise examination of every single claim, every single adjustment, and every single AR item will be conducted.
HIPAA-compliant systems used for this audit will enable the secure handling of your patient data throughout the audit process.
Benefiting from the Swiftcare Billing audit process are:
- Private Practice physicians/solo or small groups
- Multi-provider group practices
- Hospital departments and outpatient facilities
- Specialty clinics (cardiology, orthopedics, behavioral health, physical therapy)
- Providers with excessive denial rates or delayed reimbursement
Take Control Of Your Practice's Revenue Today.
Swiftcare Billing audit provides your practice with clarity, confidence, and actionable recommendations to increase revenue. Schedule your free audit today to find missed charges, optimize your workflow, and improve compliance.
Frequently Asked Questions
What will a Swiftcare Billing audit involve?
Audits will examine coding accuracy, submitted claims, accounts receivable, posted payments, and denied claims. Audits will also evaluate compliance with payer regulations and standards. Each audit includes a comprehensive report detailing all findings and recommendations to improve revenue.
How long will it take to complete the audit?
The time required to perform the audit will depend on the number of providers at your facility, the number of claims submitted, and the complexity of the specialty services billed. Typically, audits are completed within 2-4 weeks following receipt of all necessary data.
Will audits be performed for multi-site practices?
Audits may be conducted for multiple locations or practices. Each location/site will be evaluated separately to ensure coding, claims, and revenue cycle performance are evaluated for each location.
Are patient records secured during the audit process?
Patient data will be protected and maintained in accordance with the highest level of HIPAA-compliant procedures. All information will be stored in encrypted systems, and access will be strictly limited to trained Swiftcare Billing auditors.
Can audits identify missed revenue or underbilling?
Audits have been specifically designed to identify missed charges, improper coding, and billing inconsistencies. The audit findings will clearly define areas where revenue may be recovered or where claim processing may be improved.
Do you provide recommendations following the audit?
Each audit will conclude with a detailed report identifying errors, patterns, and/or opportunities for improvement. Recommendations will include adjustments to coding, improvements to the workflow, and the implementation of compliance measures.
Are audits suitable for all medical specialties?
Audits may be tailored to meet the needs of any medical specialty, including primary care, mental health, surgery, orthopedic, and multi-specialty practices. The audit process will be modified to accommodate the specific billing requirements of each specialty.
Get in Touch With Our Billing Specialists
Have questions or need support? Our team is here to guide you with credentialing, billing, coding, and A/R solutions tailored to your practice. Reach out now to get started.