MEDICAL BILLING AUDIT SERVICES

Medical Billing Audit Services That Show Where Revenue Is Leaking

SkyLine MB reviews coding, charge capture, modifiers, payments and documentation on an agreed sample — then explains each finding, its likely impact and the corrective action.

FREE CONSULTATION

Request a billing audit

Tell us about your specialty, providers and the concerns behind the audit. An audit specialist will contact you to agree scope and sample — no obligation.

Please do not include patient information. By submitting, you ask us to contact you about your enquiry. Read our Privacy Policy.

Agreed sample

Scope set before review

Chart-level

Coding & documentation

Written report

Findings and actions

Follow-up

Re-review available

Every finding tied to the record

OVERVIEW

What Is a Medical Billing Audit?

A medical billing audit compares what was billed with what the medical record, coding guidelines and payer rules support — and checks whether the practice was paid correctly.

Audits can look back at paid claims, review claims before submission, focus on one provider or code family, or test payments against contracts. SkyLine MB agrees the scope and sample first, then reports findings and corrective actions you can act on.

Who it's for

Practices worried about coding, denials, underpayments or compliance

What's reviewed

E/M levels, CPT/ICD-10, modifiers, charges, payments

How it's priced

Fixed fee for an agreed scope and sample

Deliverable

Written findings, impact and a corrective action plan

THE CHALLENGE

Why Practices Need a Medical Billing Audit

Billing reports show what was paid — not what was missed, overcoded or underpaid.

3 years

Medicare Recovery Audit Contractors can generally review claims up to three years after the paid date. — CMS

Oct 1

ICD-10-CM updates take effect every October 1, so coding habits need regular review. — CDC/CMS

E/M level errors

Levels that don’t match documented MDM or time create risk in both directions.

Missed charges

Services documented but never billed are lost revenue.

Modifier errors

Unsupported modifiers and wrong code combinations draw denials or recoupments.

Underpayments

Payments below contracted rates often go unnoticed in posting.

Documentation gaps

Billed services the record doesn’t support are a compliance risk.

Repeat denials

The same denial reasons return when no one traces the cause.

An audit is not only about finding mistakes. It explains why they happen and what to change so they stop.

WHAT'S INCLUDED

Medical Billing Audit Services We Provide

Choose the audit type that fits your concern. We agree claims, time period, providers, sample and review method before work starts.

Retrospective Audits

Paid claims reviewed against the record and payer rules.

Prospective Audits

Claims reviewed before submission so issues are corrected first.

E/M & Coding Audits

E/M levels, CPT, ICD-10-CM and modifiers checked by coders.

Learn more →

Charge Capture Review

Documented services compared with what was actually billed.

Payment & Contract Audit

Payments compared with contracted rates and fee schedules.

Learn more →

Denial Pattern Review

Denials grouped by reason, payer and code to find root causes.

Learn more →

Compliance-Focused Review

Reviews aligned with OIG compliance program guidance.

Corrective Action Plan

Findings turned into fixes, education and a follow-up review.

Also available:

HOW IT WORKS

Our Medical Billing Audit Process, Step by Step

Six stages from scope to follow-up. Before we start, we agree the claims, period, providers, sample method and how findings will be reported.

STEP 01

Scope & objectives

Concerns, period, providers and specialties agreed in writing.

STEP 02

Sample selection

A random or targeted sample chosen to fit the audit goal.

STEP 03

Chart-level review

Codes, modifiers and units compared with the documentation.

STEP 04

Payment review

Payments, adjustments and denials compared with expected rates.

STEP 05

Findings report

Each finding explained with its source, impact and recommendation.

STEP 06

Corrective action

Fixes, provider education and a follow-up review agreed with you.

IN-HOUSE VS. OUTSOURCED

External Billing Audit vs. Internal Review

Why an independent review often finds what routine checks miss.

Compare staffing, scope and oversight before choosing a model
What matters	In-house	SkyLine MB (outsourced)
Independence	Staff review their own work	An outside team reviews the claims
Coding depth	Depends on internal coding skill	Coders review chart-level detail
Payment checks	Totals reviewed, not line items	Payments compared with contracts
Sampling	Often informal	Defined random or targeted sample
Findings	Verbal or ad hoc	Written findings with sources
Corrective action	Depends on available time	Action plan and follow-up review
Staff time	Pulled away from daily billing	Your team supports, we review
Security responsibilities	Practice safeguards and access	Shared responsibilities, a BAA and agreed access

Audits are most useful when findings feed back into daily work — through coding, payment posting and denial management.

PRICING

How Much Does a Medical Billing Audit Cost?

Audit pricing depends on the audit type, sample size, number of providers and how deep the review goes.

Fixed audit fee

One price for an agreed scope, sample and report. The most common approach.

Depends on sample and depth

Best for a one-time review

Per chart reviewed

A fee for each chart or claim reviewed, useful for focused coding audits.

Rate depends on chart complexity

Best for targeted coding reviews

Recurring review

A scheduled quarterly or monthly audit on a smaller sample.

Varies by frequency and sample

Best for ongoing compliance monitoring

HOW SKYLINE MB PRICES

A clear audit quote before any review starts

Your quote reflects audit type, sample size, providers, specialties and the report you need. We confirm scope, timing and follow-up in writing before we start.

TRANSPARENT REPORTING

What Our Audit Reports Measure

Every report uses agreed definitions so results can be compared over time.

Coding accuracy

Sample result

Lines coded correctly ÷ lines reviewed in the sample.

Error types

Finding mix

Findings grouped by E/M, CPT, ICD-10-CM, modifier and units.

Missed charges

Charge capture

Documented, billable services found without a charge.

Underpayments

Payment variance

Line items paid below the expected contracted amount.

Documentation support

Compliance

Billed services fully supported by the record ÷ services reviewed.

Follow-up change

Improvement

Change in accuracy between the first audit and the follow-up review.

Audit results describe the sample reviewed. Findings are recommendations; final coding and billing decisions remain with your practice.

SPECIALTIES

Billing Audits for 20+ Specialties

Every specialty has its own codes, modifiers and payer rules. Pick yours to see how we support it.

EHR & PM SYSTEMS

Works Inside Your Current EHR

We assess your current EHR and practice-management workflow first, then agree access and handoffs with your team.

Using another system? Tell us which platform you use so we can confirm compatibility and access requirements.

TECHNOLOGY

Audit Analytics With Human Chart Review

Data tools surface outliers, denial clusters and payment variances fast. But audit findings need a person reading the chart and the payer rule — so every flag is confirmed by review.

COMPLIANCE & SECURITY

HIPAA-Compliant Billing Audits

Audits require access to records and remittances. We sign a Business Associate Agreement and limit access to the sample agreed for review.

FREE AUDIT CONSULTATION

Not sure what kind of audit you need?

Tell us what’s worrying you — denials, E/M levels, underpayments or compliance. We’ll suggest a scope, sample and timeline before any work starts.

What happens next: send your practice details, speak with a specialist, then agree a secure way to share anything needed for the review. Do not send patient records through this enquiry form.

CLIENT STORIES

What Practices Say About SkyLine MB

Independent practices, specialty groups and clinics trust us with the work that keeps revenue moving.

Our denials used to sit for weeks. Now every denial has an owner, a reason code and a next step — and we see it all in one monthly review. It's the first time billing hasn't felt like a black box.

Therapy billing has so many visit limits and modifier rules. The team caught authorization gaps before they turned into denials, and our front desk finally stopped chasing payers.

Switching billing partners scared us, but onboarding was organized from day one. They worked inside our existing EHR, so my staff didn't have to learn anything new.

Telehealth codes, payer-specific policies, credentialing — they handled all of it. Having one billing manager who actually knows our practice makes a real difference.

We get clear answers on why a claim was underpaid and what's being done about it. The monthly KPI call is something our physicians now look forward to.

High visit volume means small errors add up fast. Clean claims go out quickly and the A/R follow-up is consistent — no more old balances quietly aging out.

FAQ

Frequently Asked Questions About Medical Billing Audits

Straight answers to what practices ask before choosing a billing partner.

Still have a question?

Talk to a billing specialist — no sales pressure.

Related Services

Medical Coding

Certified ICD-10-CM, CPT and HCPCS coding.

Learn more →

Denial Management

Root-cause fixes and appeals.

Learn more →

Revenue Cycle Management

Front-end to final payment.

Learn more →