Medical Billing & Coding Audits That Find Errors Before Payers Do
Alpha RCM Solutions reviews your charts, codes and claims to find coding errors, documentation gaps, missed charges and compliance risks, then gives you a clear report on what to fix.
- Codes checked against the medical record
- Claims reviewed for denials, underpayments and missed charges
- A written report with clear next steps
Request a Free Audit Consultation
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What a Medical Billing Audit Actually Checks
An audit is a check-up for your billing. We compare what was documented, what was coded and what was billed and paid, so errors are found and fixed before they turn into denials, repayment requests or penalties.
Coding accuracy. Do the diagnosis, procedure and E/M codes match what the record supports?
Documentation. Is every billed service backed by complete, specific documentation?
Claims and revenue. Were all charges captured, and were claims paid correctly by the payer?
Our Medical Audit Services
Pick one audit or combine several, depending on where you think the problems are.
Medical Billing Audit
End-to-end review of claims across Medicare, Medicaid, commercial and self-pay.
Coding Audit
Codes compared with the record to find upcoding, undercoding and wrong or missing modifiers.
Clinical Documentation Audit
Provider notes reviewed for gaps that weaken medical necessity or leave charges unsupported.
Pre-Bill Claim Review
A second check on claims before submission so errors never reach the payer.
Denial & Underpayment Review
Remittances checked for denied and underpaid claims, with causes traced back to the source.
A/R Aging Audit
Open balances reviewed by age and payer to find claims that stalled or were never followed up.
Medicare Chart Review
Medicare patient charts reviewed against documentation and coverage requirements.
Payer & Government Audit Support
Help preparing records and responses for payer or government audits such as TPE, RAC, OIG and DMEPOS reviews.
Compliance Risk Review
Billing patterns checked for outliers and red flags that could draw payer scrutiny.
How Our Audit Process Works
A structured review that ends with findings you can act on.
1Scope & sample
We agree what to audit: specialties, providers, payers, date range and a sample of charts and claims.
2Secure record access
We receive the charts, claims and remittances for the sample through an agreed, secure method.
3Chart-to-claim review
Auditors trace each encounter from documentation to codes to the claim and the payment received.
4Findings & error types
Every error is logged and classified, such as coding, documentation, charge capture or payer processing.
5Report & recommendations
You get a written report with error rates, examples from the records, revenue impact and recommended fixes.
6Fix & follow-up
We walk your team through the findings and can re-audit later to confirm the errors are gone.
Sample size and timeline depend on your volume and the audit type. We agree both with you up front.
What We Review
- Patient charts and provider notes
- Superbills, charge sheets and claims
- Remittances and EOBs
- Denial and A/R reports
- Fee schedules and payer contracts, where relevant
- Secure access to your records or EHR
Problems Audits Uncover
Billing errors are rarely obvious from the inside. These are the ones we find most often:
- Upcoding and undercoding
- E/M levels not supported by the documentation
- Missing or incorrect modifiers
- Charges that were never captured or billed
- Duplicate or incorrect billing
- Underpayments the payer never corrected
Why Audit Before a Payer Does
Small, repeated errors add up to lost revenue, and payers can recoup overpayments or open their own reviews. Finding problems yourself lets you fix them on your terms. Audit findings also feed straight into medical coding and denial management so the same errors stop recurring.
- Recover revenue lost to errors and missed charges
- Reduce denials by fixing errors at the source
- Lower the risk of payer recoupments and audits
- Give providers specific documentation feedback
- An independent view of your billing and coding
- Plain-language reports, not just spreadsheets
Who We Audit For
Audits scaled to a solo practice, a multi-specialty group or a facility.
See the specialties we support.
Medical Audit FAQs
Straight answers to the questions practices ask us most.
A medical billing audit is a structured review that compares the medical record, the codes assigned and the claims submitted and paid. It finds coding errors, documentation gaps, missed charges and compliance risks so they can be corrected.
A coding audit checks that diagnosis, procedure and modifier codes match the documentation. A billing audit looks wider: charge capture, claim submission, payer payments, denials and A/R. Many practices combine the two. See our medical coding services.
It depends on your volume, number of providers and the type of audit. We agree on a sample size with you at scoping so the results are meaningful for your practice.
A written report covering error rates, examples from the records, estimated revenue impact and recommended fixes. We also walk your team through the findings.
Yes. We can help you prepare records and responses for payer or government audits and reviews. Outcomes depend on the payer and your documentation, so we cannot guarantee a result.
We follow HIPAA privacy and security requirements when handling protected health information. Ask us about the specific safeguards that apply to your account and we will walk you through them.
Pricing depends on the audit type and the size of the sample or practice. Request a quote or use the form above and we will send one.
Yes. We can work with your staff on the fixes, or take on medical billing and denial management so errors are corrected at the source.
Explore Related Services
Medical Coding
Accurate ICD-10-CM, CPT and HCPCS coding for every setting.
Medical Billing
Claims, payment posting and follow-up handled by one team.
Denial Management
Fix denials, appeal what is owed and prevent repeats.
Revenue Cycle Management
End-to-end revenue cycle support for your practice.