Medical billing and RCM audit
A free look at where revenue may be slipping, from denials and aging A/R to coding and underpaid claims, with a deeper paid audit when you want one.
Most practice owners know something is off before they know what it is. Collections feel low for the volume, A/R keeps growing, or the same denials show up every month. Without a structured review, it is hard to tell whether the problem is coding, the front desk, payer behavior, or the billing process itself.
SFA Solutions offers a free practice audit with no commitment, and no patient records are needed to request an initial review. We review your billing and walk you through where revenue may be slipping. The free review is designed to identify potential issues across claim denials, coding, underpayments, aging A/R, eligibility, prior authorization, missed charges, billing workflows, payer issues, credentialing, claim submission and collection opportunities. For practices that want more depth, the paid full audit adds a coding sample against documentation, a payer-by-payer underpayment check against your contracted rates, a review of front-end workflows, and a report of findings. We keep the review fair to your billing team: issues caused by payer behavior or practice-side workflow are separated from billing performance.
Who this is for
An audit is useful for any practice that suspects lost revenue, practices considering a switch in billing company, owners buying or merging a practice, and groups preparing for a payer audit or a records request. It is also a sensible yearly check for practices that bill in-house.
Related services
What our medical billing audit service covers
KPI benchmarking
Days in A/R, A/R over 90 days, first-pass rate, denial rate and net collection rate compared to common benchmark ranges.
Denial analysis
Denials grouped by CARC code, payer and cause, with the likely preventable share called out.
A/R aging review
Open balances by bucket and payer, with claims near timely filing or appeal deadlines flagged for immediate action.
Coding sample
In the paid full audit, a coding sample checked against documentation, showing E/M distribution, modifier use and diagnosis specificity.
Underpayment check
Paid amounts compared to your contracted fee schedules to find payers that are paying short.
Walkthrough of findings
A call to walk you through the potential issues we found. The paid full audit also includes a report of findings.
How we deliver it
Request
Call (737) 600-8899 or email info@sfasolutions.net. We send a short list of summary reports to pull from your PM system.
Review
We look at your aging, denial, payment and charge summaries. The paid full audit adds a coding sample and contract rate check.
Findings
We list the potential issues we found and where revenue may be slipping. A paid full audit includes a report of findings.
Walkthrough
We go through the findings with you on a call. You can address them with your current team or ask us to help.
Audit areas and the red flags we look for
| Audit area | What we review | Red flag |
|---|---|---|
| A/R aging | Balances by bucket, payer and provider | More than 15% to 20% of A/R older than 90 days |
| Denials | Denial rate, top CARC codes, appeal outcomes | Denial rate above 5%, or the same top codes month after month |
| Collections | Net collection rate and payment trends | Net collection rate below 95% |
| Coding | E/M level distribution and modifier use by provider | Clustering at one E/M level, or modifier 25 or 59 on most claims |
| Payments | Allowed amounts vs. contracted rates | Repeated short payments from the same payer or CPT code |
| Charge lag | Days from service to claim submission | Claims routinely leaving more than 3 to 5 days after the visit |
Medical Billing Audit for your specialty
We bill for 28+ specialties. These are the ones we work with most.
Nurse Practitioner billing
Billing for NP-led and physician-NP practices, from the 85% Medicare rate and incident-to rules to split/shared visits and getting each NP credentialed under the right NPI.
Learn moreInternal Medicine billing
Billing for internists who manage complex, chronic patients, with E/M levels, wellness visits and care management codes captured when the documentation supports them.
Learn moreOphthalmology billing
Eye exam codes, refraction, diagnostic testing, cataract globals and high-cost injectable drugs all follow their own rules. Ophthalmology is one of the specialties we bill most often.
Learn moreQuestions about medical billing audit
Is the audit really free?
Yes. The practice audit is free and carries no commitment. You keep the findings whether or not you work with us.
What do you need from us?
For the initial review, summary reports from your practice management system: A/R aging by payer, denial or adjustment summaries, payment summaries and charge totals for a recent period. No patient records are needed to request an initial review. The paid full audit also includes a coding sample and your contracted fee schedules, handled under a signed business associate agreement.
How long does the audit take?
Timing depends on your claim volume, the number of payers and how quickly your reports are available. We give you an expected timeline once we receive them, and a paid full audit with a coding sample and contract review takes longer than the free review.
Will the audit blame our current biller?
No. We separate issues caused by billing work from those caused by payer behavior, documentation or front-desk workflow, so the findings are fair and the fixes go to the right people.
What happens after the review?
You can fix the issues with your own team using the findings as a checklist, or ask SFA to take on billing, denial work or A/R recovery. There is no pressure either way.
Start with a free review
Tell us a little about your practice. We will look at where medical billing audit is costing you money today and walk you through what we find.
- No commitment
- Reply from an RCM specialist, typically within one business day
- No patient records needed to start
Get a free review
An RCM specialist typically replies within one business day.