Medical Billing Audit Services That Stop Revenue Loss
CMS audits show documentation and coding errors drive improper payments every year. We prevent those errors before claims ever leave your system.
East Medical Billing coders review documentation. assign accurate ICD CPT HCPCS. apply NCCI and payer edits. Confirm LCD and NCD coverage. answer provider queries the same day. Your claims move through payers without avoidable rework.
Why Medical Practices Need an RCM Audit & Consultation
35% denied claims and $250K in lost annual revenue, cardiology billing is high-stakes, and your practice is paying for it. Evolving CPT codes, strict modifier rules, and high-cost procedures stall reimbursements and trigger audits. From bundled imaging issues to delayed TAVR authorizations, your practice revenue is leaking.
- Up to 5 - 10% of annual revenue is lost due to billing and coding errors
- 20 - 30% of claims are denied at least once before payment
- Practices wait an average of 30 - 45 extra days due to unresolved AR issues
- Most providers rely on reports that don’t reveal root causes
These challenges usually stem from constant payer rule changes, staffing gaps, outdated workflows, and a lack of visibility into billing performance. Providers are focused on patient care, not chasing denials or tracking underpayments.
That’s exactly when an audit and consultation become critical, when revenue feels tight, denials rise, or growth stalls without a clear reason. A timely review brings clarity, control, and a clear path to stronger financial performance.
Front-End & Registration Issues
- Eligibility errors (18%)
- Missing authorizations (14%)
- Incomplete patient data (22%)
- Coverage misverification (16%)
Claims & Denials Issues
- Clean claim failures (26%)
- Avoidable denials (30%)
- Untimely submissions (18%)
- Rejected claims ignored (20%)
Reporting & Compliance Issues
- Inaccurate billing reports (31%)
- Missing KPIs tracking (34%)
- Compliance risks unnoticed (16%)
- Audit readiness gaps (21%)
- Limited revenue visibility (38%)
Audit-First & Action-Driven Approach to Fix Revenue Problems
Our Medical Billing Audit and RCM Consultation are built to identify the exact points where revenue breaks down, and then correct them with clear, measurable actions tailored to how your practice actually operates.
End-to-End Revenue Cycle Mapping
We audit every handoff from patient intake to final payment, tracing how data, charges, and claims move through your workflow.
Claim-Level & Coding Accuracy Review
Our audit goes down to the claim and encounter level, comparing documentation against CPT, ICD-10, and modifier usage.
Denial Root-Cause Analysis
Instead of grouping denials broadly, we break them down by payer, reason code, service line, and timing.
AR & Underpayment Deep Dive
We analyze aging AR, stalled balances, and payment variances to uncover underpayments and follow-up gaps.
Workflow & Team Performance Assessment
We evaluate how tasks are assigned, tracked, and followed up on across your billing operation.
Actionable Roadmap & Advisory Guidance
You receive a clear, prioritized action plan, not just findings, aligned with your goals, volume, and specialty.
Smarter Medical Billing Audits That Protect Revenue and Compliance
At CitrusBits, we help healthcare organizations take the stress out of billing by combining deep domain knowledge with practical, real-world experience. Our approach to billing audit services and healthcare revenue cycle management is conversational, collaborative, and focused on results, so you always know where your revenue stands and how to improve it. Instead of surface-level checks, we dig into your billing workflows, payer interactions, and documentation practices to uncover what’s really holding you back. The result is clearer billing operations, stronger compliance, and a more predictable revenue stream you can trust.
- 30% Cost Optimization
- 2× Cash Flow
- 45% Process Efficiency
- 90% Audit Readiness
- 50% Error Elimination
Spot and fix billing errors before they impact revenue
We review claims, coding accuracy, and charge capture processes to identify hidden mistakes that often go unnoticed. These corrections reduce rework, lower denial rates, and prevent the same issues from recurring.
Unlock missed revenue and improve reimbursement accuracy
Our audits uncover underpayments, missed charges, and payer discrepancies, helping you recover revenue that’s already been earned. This ensures reimbursements fully align with services provided.
Strengthen compliance and reduce financial risk
By aligning your billing practices with regulatory and payer requirements, we help you stay audit-ready. This proactive approach minimizes exposure to penalties, fines, and unexpected compliance issues.
Turn billing data into actionable insights
We analyze trends across claims, denials, and payment timelines to highlight performance gaps. These insights make it easier to optimize workflows and improve long-term financial outcomes.
Create transparency across the entire billing process
Clear reporting and structured workflows give your team better visibility into billing operations. This transparency improves internal coordination and builds greater trust with patients and stakeholders.
Create transparency across the entire billing process
Advanced Coding & Billing Risk Expertise You Can Rely On
Billing risks don’t just affect revenue; they expose practices to audits, payer disputes, and compliance issues. As part of our Medical Billing Audit Services, East Billing applies a focused, evidence-based review to identify high-risk billing behaviors and guide the next corrective steps through targeted consultation and coding oversight.
| Billing Risk Area | What We Identify During The Audit | How East Billing Addresses It |
|---|---|---|
| Upcoding | We detect instances where billed codes don’t align with documentation or service complexity, often triggered by E/M level inconsistencies or modifier misuse. | Our audit flags affected encounters and recommends a follow-up medical coding audit to correct patterns, retrain staff, and reduce audit exposure. |
| Unbundling | We identify services billed separately when payer rules require bundled billing, leading to overpayments or future recoupments. | We review payer-specific bundling rules and revise charge capture and coding workflows to ensure compliant, accurate billing going forward. |
| Double Billing | We uncover duplicate claims or repeated submissions caused by system issues, reposting errors, or workflow breakdowns. | Our consultation focuses on claim submission controls and posting checks to eliminate repeat billing and payer disputes. |
| Phantom Or Fake Billing | We audit billed services against scheduling, encounter data, and documentation to identify services with no clinical support. | We help practices tighten internal controls, documentation standards, and charge validation processes to prevent serious compliance risks. |
| Medically Unnecessary Services | We assess whether billed services meet payer medical necessity guidelines and diagnosis-to-procedure alignment. | Our advisory guidance helps align documentation, coding, and clinical workflows to reduce denials and protect against payer allegations. |
Specialized Audit & Compliance Expertise Built for Modern Healthcare
East Billing combines hands-on industry experience with advanced audit methodologies to deliver audits that go beyond surface-level findings. Our approach blends medical coding audit and review, technology-driven insights, and strict compliance standards to protect revenue, reduce risk, and strengthen long-term billing performance.
AI-Powered Audit Solutions
- Automated anomaly detection
- Revenue leakage identification
- Denial and underpayment trend insights
Healthcare Billing and Coding Audits
Our medical coding audit and review process evaluates both billing accuracy and documentation integrity to ensure claims are compliant, defensible, and correctly reimbursed. We focus on precision, not assumptions, reviewing real encounters, real codes, and real payer outcomes.
- CPT, ICD-10, and modifier accuracy checks
- Documentation-to-code alignment review
- Reimbursement accuracy validation
Why Healthcare Providers Choose East Billing for Audit & Consultation
Choosing the right audit and RCM partner isn’t just about reviewing reports; it’s about trust, accountability, and real results. At East Billing, our Audit Services are built on deep revenue cycle expertise, hands-on analysis, and a clear understanding of how payer behavior impacts your bottom line.
We don’t offer one-size-fits-all audits or automated summaries. Every audit and consultation is tailored to your specialty, payer mix, and operational structure, ensuring you receive insights you can act on immediately, not months later.
- Built by revenue cycle specialists, not generic consultants
- Designed to protect both reimbursement and compliance
- Focused on outcomes, not just observations
Audit + Action Approach
We don’t stop at identifying problems. Our consultation provides a prioritized, step-by-step plan to fix revenue leaks and prevent them from returning.
Claim-Level, Not Surface-Level Reviews
Our audits go beyond dashboards and KPIs, drilling down to encounters, codes, and payer responses to uncover real issues.
RCM Specialists Across the Full Cycle
From front-end intake to AR recovery, our team understands how each step impacts revenue and audits accordingly.
Technology-Enhanced, Human-Led
We use advanced analytics to spot patterns, but every finding is reviewed and validated by experienced billing and coding professionals.
Our Clients Reviews
Central Scheduling
11 months ago
Awesome and efficient
company to work with! Same
day responses and helpful with
any questions/concerns!
Central Scheduling
11 months ago
company to work with! Same
day responses and helpful with
any questions/concerns!
Central Scheduling
11 months ago
company to work with! Same
day responses and helpful with
any questions/concerns!
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