Medical Bill Audits

The complexity of reimbursement systems and claims methodology creates ample opportunities for both intentional and inadvertent billing errors. Medical bill audits are a critical tool for ensuring the efficient and appropriate use of healthcare dollars.

Submitted healthcare claims are compared side-by-side against medical records to verify that the treatment claimed for reimbursement was actually performed. Issues of unbundling (billing separately for services that should be billed as a single item); incorrect coding of procedures, including compliance with NCCI edits and other standard coding procedures; and others are routinely discovered.

Our Certified Coding specialists, Registered Nurses, auditors (including Certified Fraud Examiners when appropriate), physicians, and other healthcare professionals apply proprietary algorithms to deliver a high return on investment for our clients.