Billing Audit Readiness: Keep Your Practice in Order and Protect Your Revenue

Billing audits aren’t just for large hospitals or high-risk specialties — they can happen to any healthcare provider, including outpatient clinics, behavioral health programs, and solo practices. Whether it’s a payer-led review, a Medicaid compliance check, or a response to a denied claim, your ability to pass an audit depends on one thing: billing audit readiness.

We help practices stay organized, compliant, and ready, so audits don’t turn into liabilities.

⚠️ Why Billing Audits Happen

Insurance payers, government programs (like Medicaid), and clearinghouses may initiate audits when they see red flags such as:

  • Increased claim volume

  • Repetitive coding patterns

  • High usage of high-reimbursement codes

  • Claims without supporting documentation

  • Past denials or appeal histories

  • Delayed or excessive resubmissions

📌 Whether you’re targeted for cause or part of a random review, preparation is key.

📋 Billing Audit Readiness And What Billing Auditors Look For

Across specialties, audit teams typically check for:

✅ 1. Proper Documentation

  • Detailed session or visit notes

  • CPT/HCPCS codes that match services provided

  • Signed provider documentation

  • Supporting documentation for time-based billing

✅ 2. Authorization & Eligibility Records

  • Proof of active insurance coverage

  • Prior authorizations for covered services

  • Notes showing services occurred within authorized timeframes

✅ 3. Accurate Coding & Modifiers

  • No upcoding or unbundling

  • Correct use of modifiers (e.g., -25, -59, -GT, -95)

  • Documentation that matches code level (especially for E/M or therapy sessions)

✅ 4. Compliance with Timely Filing

  • Submissions made within each payer’s filing window

  • Records showing the date of service match the date of submission

✅ 5. Provider Credentials

  • Proper credentials for billed services (e.g., RBT, LCSW, MD)

  • Current NPI and licensing records

  • Active enrollment with payer networks

🧠 Signs Your Practice May Not Be Audit-Ready

  • You’re unsure how long you must keep billing records

  • Providers don’t document sessions immediately

  • There’s no internal billing SOP

  • You rely on one person for all billing and coding

  • Denials are increasing, but you’re not sure why

  • There’s no system to track authorizations or treatment plan expirations

Sound familiar? That’s where we come in.

🛠️ Proactive Steps to Ensure Billing Audit Readiness

Here’s how to boost your billing audit readiness starting today:

  1. Standardize Documentation
    Use templates and checklists to ensure every visit/note includes the right info.

  2. Audit Your Claims Internally
    Sample 5–10 random claims/month. Check coding, notes, and authorizations.

  3. Stay Current on Payer Policies
    Know the rules for your top 5 payers — and review updates quarterly.

  4. Train Your Staff
    Ensure everyone (clinical + billing) understands what’s required for clean claims.

  5. Create a Billing SOP Manual
    This sets a standard for how claims are submitted, corrected, and tracked.

🤝 Our Billing Audit Readiness Keeps You Audit-Ready

Whether you’re an ABA clinic, mental health provider, or multidisciplinary group, we help you prevent problems before they start.

We provide:

  • Monthly or quarterly chart audits

  • Documentation reviews and feedback

  • SOP creation and staff training

  • Claim scrubbers to catch issues before submission

  • Denial tracking and appeal support

  • Full-service billing and AR management

📞 Call us today at 844-TAYLOR-9 (844-829-5679)
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📧 Send us an email  

Billing Audit Readiness