Practices lose revenue to errors they never catch. A gap in documentation or a missed modifier is enough to trigger a claim denial. So how do you find these errors before they cost you? Our medical billing audit services help you identify the root causes of claim denials across your revenue cycle. With MedCare MSO’s certified team, you can find the weak areas draining your practice’s revenue cycle and finally collect the revenue you’re entitled to, with expert auditors on your side.
Book A Free Consultation40%
Revenue Improvement
45%
Fewer Denials Ratio
35%
Reduction in A/R
Are medical billing audits necessary? Three numbers answer that. Medicare's own reviewers keep finding billions in ordinary billing errors and the same errors sit quietly in ordinary practices' claims until someone looks.
The FY 2025 review through CMS’s CERT program put the fee-for-service improper payment rate at 6.55%, not fraud, according to CMS, but ordinary errors. Our audit helps find those same errors in your claims before they pile up.
If you get an overpayment from Medicare, you have 60 days from identifying it to report and return it. Our medical coding audit services help find overpayments early, not in the middle of a payer review.
Reviewers check a sample of claims. If they find a pattern of mistakes, they apply it to everything you billed the same way, a process called extrapolation. We help catch the pattern first, in a sample nobody penalizes you for.
If any of these sound familiar, your claims are due for a review:
Even one of these is enough. Our billing audit tells you whether it’s a one-off or a pattern quietly costing you every month.
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Not every billing audit does the same job. Here are the six types, and what our team does in each one:
WHEN IT HAPPENS
Claims are reviewed before submission
What we do: Check codes, modifiers, and documentation before the claim is submitted, so errors never reach the payer.
Submitted claims are reviewed
What we do: Identify denial patterns and underpayments in what you already billed and find what's recoverable.
WHO RUNS IT
Your in-house team performs audits.
What we do: We help you build it. Our team creates review checklists, coding spot-check routines, and training for your staff.
An independent, certified review of your claims.
What we do: Our CPC-certified auditors review your claims against payer rules and benchmarks a single practice doesn't have.
HOW WIDE IT GOES
One target: a single payer or denial reason.
What we do: Identify the problem area and dig deeper to find exactly where the problem is.
The end-to-end revenue cycle analysis.
What we do: Audit everything once and set your baseline, so every future audit has something to measure against.
Medical practices make the internal vs external audit decision on their own. Most practices start with a comprehensive billing audit, then run focused audits wherever it finds problems. Our audit experts tell you on the scoping call which one your situation actually needs.
Our medical billing audit services follow a clear process that runs in three phases and most audits move from kickoff to final report in about 2 to 4 weeks, faster than the 4–6 weeks common across the industry.
The audit starts with a scoping call, where we discuss scope and decide which type of audit fits your practice. Before any work begins, we sign a Business Associate Agreement (BAA), so everything that follows happens under HIPAA rules. We confirm your timeline on this call most engagements run 2 to 4 weeks end to end.
Your team does one thing: pull the records claim details, coding logs, payer contracts, and clinical notes. From there, our CPC-, CPMA-, CCS-, and CEMC-certified team reviews your documentation, checks payer-specific rules and NCCI edits, and finds the root cause of each denial. For most reviews we pull 10 to 30 claims per provider a sample large enough to expose a pattern without tying up your team, scaled to your claim volume.
When the audit is complete, we share the findings and walk you through them in detail. We help train your staff and give you a recovery plan for your practice — a system built to keep claim denials from coming back.
Every engagement ends with a written audit report you can act on not a vague score. Your report includes:
Unnoticed billing errors drag your revenue down quietly. Upon acting on the findings of an audit, you get cleaner codes, better documentation standards, and billing workflows that result in consistent, clean claim rates, shorter AR cycles, and stronger payer compliance.
Once we are done with your medical billing audit, the story does not end here. We help you with sessions that are created from your billing review. Based on your claims analysis, we help your team learn what are the reasons for denials. Your team also builds a habit of reviewing claims regularly. We help you:
You learn exactly what payers need to see in the notes drawn from the real claims where it was missing.
E/M leveling, modifier use, and unbundling — corrected against your own denial history, not textbook examples.
Checklists and spot-check habits your team runs between audits, so problems surface in weeks, not years.
Fee schedules, E/M requirements, and payer policies shift every year; we keep your team briefed on the changes that affect your claims.
Vaccine coding, program rules, the age-18 flip, family coverage changes, every challenge above is a place claims quietly die. Our team finds the leaks and fixes the process behind them.
Get a Free Billing ReviewOur audits aren’t done completely manually. Yes, we put in place professionals for every process but Maximus, our medical billing software, works alongside our certified auditors, the software finds the patterns, and the auditors judge them. No finding reaches your report without human review. It has the ability to cross-reference claims, codes, and documentation against CMS guidelines, payer contracts, and benchmarks in real time.
Our medical billing audit company offers specialty-specific audit services for practices of every size.
I highly recommend MedCare MSO if you are looking for help with your billing and gain some freedom to see more patients or manage your business.
Practice Owner, TXEC
MedCare MSO has been an excellent organization to work with, I highly recommend them for their quality of service and commitment to excellence.
Back Office Manager, STST
We are definitely impressed by the Team’s performance. I worked with a lot of different folks from all over the world on different business transactions, and Mark is truly a top notch talent!
Director of Corporate Development, SC & SF
MedCare MSO’s exceptional communication and expertise elevated our RCM experience and my bank accounts!
Owner, R.D.
MedCare MSO did a great job with our billing and helping clean up old AR. Regular updates and good communication were very appreciated.
Co-Owner, PCP
Chief Operating Officer, MAKO MEDICAL LABORATORIES
Chief Executive Officer, CARE NOW CLINIC
Chief Operations Officer, ION DIAGNOSTICS
Co-Founder, AW Care
Working with MedCare MSO has been a game-changer for my practice. Their expertise in medical billing, AR management, and coding has significantly streamlined our revenue cycle, reduced claim denials, and improved cash flow. The team is proactive, detail-oriented, and always available to address my concerns.
Practice Owner, F&A Clinic
We have experienced tremendous improvements within our billing and claims department that we have entrusted MedCare MSO to manage.
President/CEO, RLT
I am impressed with MedCare MSO’s promptness to respond to any inquiries, with the time they dedicate to reviewing each one of the cases.
Practice Owner/FBH
The cost depends on the scope of the audit. A focused audit of one payer or one denial pattern costs less than a comprehensive review of your entire revenue cycle, and pricing also varies with your claim volume and the number of providers. Many practices start with our free medical billing audit, which reviews a sample of your claims and shows you where revenue is slipping, at no cost and with no obligation. After that first review, you will know exactly what a deeper audit covers and what it would cost for your practice, before you commit to anything.
A medical billing audit is a process that helps medical practices find inconsistencies in billing, identify coding errors, and review documentation. It checks four things: your claims, your codes (ICD-10, CPT, HCPCS, and modifiers), the clinical notes supporting every billed code, and each payer's own coverage and filing requirements. Audits also help practices align with payer rules, reduce financial risk, and improve the financial health of the practice.
Most audits run about 2 to 4 weeks from kickoff to final report faster than the 4–6 weeks common in the industry. A focused audit is quicker; a comprehensive review of your full revenue cycle takes longer. We confirm your timeline on the scoping call.
Yes, Everything we do, data collection, storage, and communication, falls strictly under HIPAA compliance standards. We execute a Business Associate Agreement with every client before we access or review any billing or patient data.
We need your patient records, coding logs, EOBs, claim submission, payment posting reports, remittance data, and payer contracts for an audit.
A medical billing audit identifies the root cause behind denial patterns and compliance gaps. The audit can be of a single or complete billing process and prevents denials from happening or recovers from what’s already lost.
A prospective audit is to prevent errors before submission, and a retrospective audit reviews the ones after they are denied. For most practices, it’s better to do both medical audits and get an idea where they stand in billing efficiency and compliance.
TXEC
I have worked with MedCare MSO for the past eight months, and it has been a great experience. Moses, Mark, Travis, Sebastian, and Tammy have been a pleasure to work with, as well as the rest of the team, including the credentialing folks.
I highly recommend this group and MedCare MSO if you are looking for help with your billing. They will meet with you once a week to review the issues that need to be fixed to improve your payment and capture rate.
If you are looking for help with your billing and gain some freedom to see more patients or manage your business, this is the team you need to work with.
Dr. Jose Correa
Practice Owner
TXEC
STST
MedCare MSO has been an excellent organization to work with. Mark has consistently demonstrated outstanding attention to detail, thorough documentation, and strong professionalism in maintaining accurate records of his findings.
His reliability and dedication have contributed greatly to a positive experience.
I highly recommend MedCare MSO for their quality of service and commitment to excellence. I can’t say enough good things about Mark and his company.
Thank you
Shaunna Mock
Back Office Manager
STST
SC & SF
Hi Ali, I hope this message finds you well. I wanted to give you some feedback on the team.
We are definitely impressed by the Team’s performance. Definitely what we were looking for from switching partners.
In particular Mark Zaiden has been very helpful. In my 5+ years of experience as a M&A Professional, I worked with a lot of different folks from all over the world on different business transactions, and Mark is truly a top notch talent!
Austin has done a great job of leading the communications process and keeping the train going in the right direction. Tammy and some other folks have been key players as well. We really are happy with everyone on the team.
I wanted to pass this feedback along to you as we are really pleased with working with MedCare MSO so far.
Have a great weekend!
Max Owens
Director of Corporate Development
SC & SF
R.D.
MedCare MSO’s exceptional communication and expertise elevated our RCM experience and my bank accounts!
Most helpful is the open/responsive communication of their team with my office and each other, along with the specialty levels of expertise amongst my team for each aspect of RCM.
Kelly Ballou
Owner
R.D.
F&A Clinic
Working with MedCare MSO has been a game-changer for my practice. Their expertise in medical billing, AR management, and coding has significantly streamlined our revenue cycle, reduced claim denials, and improved cash flow. The team is proactive, detail-oriented, and always available to address my concerns.
I would like to take time to recognize two members of MedCare MSO specifically. Moses for his exceptional support and dedication. He is always responsive, and knowledgeable, and goes above and beyond to ensure smooth operations. His professionalism and commitment make a huge difference in our day-to-day workflow. George also for his quick feedback and recognition of what is needed most. He is extremely efficient and always available for clarification and to share his knowledge and expertise.
I highly recommend MedCare MSO to any healthcare provider looking for a reliable and efficient billing partner.
RLT
Hello,
I am writing this email to express our appreciation of the MedCare MSO’s team and all they have done for our business at RLT. In the past year, we have experienced tremendous improvements within our billing and claims department that we have entrusted MedCare MSO to manage. We went from having over $100k in uncollected/billed claims to now reaching near $100k in collection some months.
We are also happy to express our thankfulness that MedCare MSO is now helping us acquire new contracts with different insurance companies. This will in effect benefit everyone involved, allowing us to expand our services and provide more resources for our staff/business partners.
Please note special appreciation for the following:
David Lucas
Mario Ortega
Ambrose William
FBH
I have been a customer of MedCare MSO for one year. They have provided billing and credentialing services for my private behavioral health practice, and I am impressed with their promptness to respond to any inquiries, with the time they dedicate to reviewing each one of the cases, and with their willingness to educate me and my staff about the ever-changing rules of medical billing and the best use of coding. This is a company I Trust with my billing needs.
Dr. Neufeld
Practice Owner
FBH
