Don’t Let Errors Drain Your Practice Take Control Today
Start your free baseline. If you’re tired of chasing denials and want straightforward, practical fixes that actually move the needle, an expert billing audit is the fastest way to clarity. Finding the problems, fixing them, and ensuring they remain fixed calls on our combining of real human experience with current artificial intelligence solutions. Let us know where you are struggling, and we will point you to the clear, prioritized path to reduced stress and increased revenue.
99%
Clean Claims
first-pass claims acceptance rate
50%
Error Reduction
Reduction in Billing Errors
40+
States Served
States Served Nationwide
30%
Faster Reimbursement
After Audit Corrections
Why Choose Us
What we audit
01
Charge capture & coding accuracy
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Review CPT/HCPCS and ICD coding for accuracy and medical necessity.
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Spot missing charges and undercoded encounters.
02
Clinical documentation & CDI opportunities
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Identify documentation that fails to support coder choices, and recommended CDI improvements.
03
Denial audit & pattern analysis
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Categorize denials (technical, clinical, eligibility, bundling) and prioritize appeals for highest ROI.
04
AR & aging analysis
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Break down receivables by 0–30 / 31–60 / 61–90 / 90+ buckets and identify claims recoverable through appeal.
05
Contract & fee schedule review
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Spot payer underpayments vs. contracted fee schedules and missed incremental revenue.
06
Eligibility & prior auth review
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Check pre-service failures that created needless denials or write-offs.
07
Workflow & process gap assessment
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Evaluate intake, charge entry, coding QA, and follow-up processes with pragmatic fixes.
08
Compliance & audit-readiness
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Identify documentation that could trigger external audits (RACs, MACs) and provide mitigation steps. CMS resources on audit readiness and self-audits are a helpful baseline.
Get Expert Help Now
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Enhanced cash flow
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99% First-Pass Acceptance
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Reduce claim denials and rejections
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EHR Flexible Solutions
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Faster Reimbursements
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Real-Time Analytics & Reporting
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HIPAA-Compliant & Secure
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AI-Powered Automation
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Specialty-Specific Expertise
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End-to-End RCM Services
What Is a Medical Billing Audit?
A medical billing audit is a structured evaluation of your coding, claims submissions, payment postings, and documentation to identify:
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Coding errors (overcoding, undercoding, modifier errors)
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Compliance issues (HIPAA violations, CMS violations, commercial payer policies)
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Claim denial and rejection trends
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Underpayments or missed charges
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Process inefficiencies and training deficiencies
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We will analyze your entire process from front desk charge capture to final payer reimbursement and all the points between.
Why Sirius Solutions Global for audits
Tailored Financial Solutions for Your Family
01
Free, no-pressure baseline audit
Quantifies recoverable dollars before you sign.
02
Hybrid auditing model
Automated analytics surface anomalies; certified coders and auditors validate clinical context.
03
Denial-first ROI focus
We prioritize recoveries that fund the engagement.
04
Compliance-aware
We align audit recommendations with CMS guidance and RAC/PEPPER risk signals.
05
Transparent KPIs & reporting
AR days, denial rate, recovered revenue, and projected monthly uplift.
Our audit approach
We analyze a sample period (30–90 days) of claims to produce a Recovery & Risk Snapshot. We quantify likely recoveries (appeals, corrected claims, underpayments) and show projected ROI for our services. High-impact fixes first (appeals/denial recovery), followed by process changes to stop future leakage. If you choose to engage Sirius for RCM or appeals, we execute the plan, provide KPI dashboards, and measure outcomes. We train staff on revised workflows and produce documentation to keep improvements sustainable.
Free baseline audit
Recoverable revenue estimate
Prioritized action plan
Optional implementation
Education & handoff
AI Overview
Our Medical Billing Audit Services
You can choose a focused audit or a full-scope review. We always deliver a prioritized roadmap with clear ownership and next steps.
Types of audits we perform
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Free Baseline Revenue Audit — end-to-end review to find immediate revenue leaks and quick-win recoveries.
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Accounts Receivable (AR) Audit — analyze aged AR for collectability, denial causes, and appeal opportunities.
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Denial Root-Cause Analysis — identify top denial reasons by payer, CPT, and process failures.
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Coding & Charge Capture Audit — retrospective chart sampling to validate CPT/ICD accuracy and missed charges.
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Compliance & Medical Necessity Audit — check documentation and medical necessity against payer rules.
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Payer Contract & Payment Audit — ensure contracted rates, bundling, and fee schedules are honored.
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DME / HCPCS Audit — specialized review for durable medical equipment claims and coverage rules.
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Telehealth & Virtual Care Audit — telemedicine-specific claims and modifier validation.
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Pre-bill / Pre-submission Audit — automated + human review before claims leave your office to reduce first-pass denials.
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Targeted Provider / Specialty Audits — oncology, cardiology, wound care, OB/GYN, behavioral health — audits tailored to specialty rules.
How our AI helps
We use secure, healthcare-grade AI tools to increase the speed and accuracy of audits. Here’s how it supports the work:
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Automated pattern detection finds outlier denials, repeat payer issues, and suspect claim clusters.
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OCR & document parsing quickly extract relevant clinical text for chart review.
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Smart sampling prioritizes charts likely to yield the highest recoveries or the greatest compliance risk.
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Predictive denial scoring forecasts claims at higher risk so we can address them pre- or post-submission.
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Revenue leak detection surfaces missed modifiers, unbilled encounters, and orphan charges.
But: certified coders, auditors, and appeals specialists validate everything. AI suggests and accelerates - humans verify and act.
Frequently asked questions
Medical Billing Audit Services
You’re doing the right work treating patients. But billing mistakes, payer rules, and hidden AR can quietly erode revenue and create regulatory risk. At Sirius Solutions Global, we give clinics and ASCs a clear, no-risk snapshot of what’s recoverable and what to fix. Our free baseline medical billing audit finds coding errors, underpayments, denials trends, and process gaps then gives you a prioritized roadmap to recover revenue and reduce future leakage.