Audit Yourself So No One Else Does
You may read the word “audit” and immediately think, “no thanks.” We don’t blame you…most the time, audits imposed by a regulatory body are always stressful and sometimes catastrophic for a medical practice. However, what if there was a way to audit yourself first? CBS Medical Billing offers a medical billing audit that enables you to take a closer look at your Medical Practice’s financial wellbeing. In this blog, we’ll talk about why self-auditing and closely inspecting your own billing infrastructure might make sense for medical practice this year.
Could Your Medical Practice Be Unknowingly Losing Money?
In the tricky world of health care, billing mistakes happen more often—and cost more money—than you might think. According to the Medical Group Management Association the US health care industry could have saved $16.3 billion in 2020, or 42% of the $39 billion spent on paperwork.(MGMA) Wow! Imagine what your practice could do with just a fraction of that…
You don’t know what you don’t know. When it comes to your financials, how can you be sure things are buttoned up unless you take a good hard look with a medical billing audit?
Think of it as an opportunity to look under the hood and tune things up while the car is still running rather than when it’s dead on the side of the road and your running late. A Medical Billing Audit isn’t something to be afraid of, it’s a way to identify weak points in your systems, ensure compliance, and help you optimize your revenue cycle management procedures.
Why Auditing Your Medical Billing Matters in 2025
With insurance companies looking closely and more rules coming from groups like CMS, private insurers, and other payers, regular, self imposed medical billing audits are becoming increasingly important in the healthcare administrations landscape.
Here’s Are A Few Common Things We Uncover In A Medical Billing Audit:
- Your losing money because of simple mistakes – if rejected and delayed claims pile up, it’s easy to put them on the back burner and never get around to them. It’s quite common and results in more uncollected revenues for your medical practice than you might want to think! An audit can help identify these simple mistakes and create systems to avoid them moving forward.
- Your team could be working more efficiently – with the right billing systems in place, your team has freed up bandwidth and can then do their primary tasks, such as patient care and office administrations, with greater focus and purpose.
- Your not as compliant as you thought you were – Rules and regulations have a way of shifting out from under a medical practices policies if they don’t have dedicated attention going towards staying updated. Beyond that, Medical billing is a weird world, and it’s easy to think something is common-sense when really their is an abstract protocol that governs compliance. A self imposed audit is the est way to avoid a real audit with serious consequences.
- Your medical practice could be making more money on claims – there can be untapped insurance payouts for the services you’ve been providing. Of course, it depends on the patients coverage, but sometimes, even in standard policies, the right paperwork regarding specialty services provided by your practitioner can lead to greater payouts with no additional payment form the patient.
What A Medical Billing Audit Focuses On
A medical billing audit is detailed discovery into your revenue cycle management process from top to bottom. We assess the full lifecylce of your claims, from initial patient communications to final insurance payout. A Medical Billing audit looks at:
Correctness of Codes
Are your CPT, ICD-10, and HCPCS codes being used correctly? Coding mistakes—regardless of intention—can lead to claim denials, payment delays, or even payer audits. Accurate coding is critical to maintaining clean claims and a healthy cash flow. What to learn more about CPT coding?
Completeness of Records
Medical Practitioners are busy people by nature – it’s easy for notes to be simple, sporadic, and even non existent on certain days…But, Insurance companies need clear records to approve payments.
One important facet of records are patient records. A medical billing audit examines whether patient information and insurance details are consistently being input and accepted by payers, or if there’s any pattern of rejection that can be easily remedied here.
Our collaborator, Ken Cornel CO. is a renowned Orthotist who spent 30 years practicing managing his O&P clinic – now, when he’s not helping people with CMT, he’s helping CBS Medical Billing clients optimize their practitioner notes so we can consistently submit clean claims.
How Bills Are Sent
Following claim submission timelines can be challenging, especially during busy seasons. A medical billing audit checks whether billing systems are sending claims promptly and tracking submissions accurately. If rejections or payment delays occur, the audit can even help determine whether the cause lies within the practice—or if payers aren’t holding up their end.
Payer’s Specific Rules
Are you keeping up with each payer’s evolving rules? A medical billing audit evaluates your processes against current payer-specific requirements to ensure you stay compliant—and get paid faster.
Internal Steps & Staff Training
Are your staff consistently following best practices in billing workflows? Are they trained on the latest compliance standards and payer expectations? Audits often reveal gaps in internal processes that can be addressed through updated training or workflow refinements.
Warning Signs & Common Problems Found In Audits
Medical billing audits often uncover patterns that day-to-day operations miss—patterns that may be costing your practice revenue or compliance risks. Some common red flags include:
Billing Too High or Unbundling Charges
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Billing too high: Charging for a higher-level service than was actually provided.
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Unbundling: Separately billing for procedures that should be grouped under a single code.
Both issues can trigger payer audits and even legal consequences if not corrected.
Under billing or Missing Charges
Busy offices sometimes miss legitimate charges during long visits or complex procedures, leaving revenue on the table.
Duplicate Billing
Submitting duplicate claims for the same service is a common administrative error that leads to delays, rework, and payer distrust.
Rising Denial Rates
A sudden surge in claim rejections can signal larger problems—such as outdated coding, incomplete documentation, or poor insurance verification practices.
Non-Compliance with Billing Rules
Billing without patient consent, failing to protect patient data, or violating payer rules can result in serious penalties—and can easily be spotted in an audit. According to a 2024 report by MDaudit, audit risk increased by 61% year-over-year. Practices without strong internal audit processes are significantly more likely to face financial penalties.
Incorrect Billing for Telehealth Visits
As telemedicine becomes mainstream, billing it correctly is critical.
Misusing outdated codes for virtual visits is one of the fastest-growing reasons for claim rejections. Regular auditing ensures your telehealth billing remains accurate and compliant.
Unusual Patient Volumes or Visit Frequencies
A sudden spike in patient visits—or unusually frequent appointments for the same patient—can prompt additional payer scrutiny. Proper documentation is essential to justify medical necessity.
Insurance Verification Gaps
Failing to audit insurance eligibility before services are rendered can lead to costly denials and unpleasant patient surprises. A robust verification process prevents unnecessary billing issues down the line.
Our Proven Medical Billing Audit Process
At CBS Medical Billing & Consulting Services, we don’t just do audits, we create solutions. With many years of experience helping with medical billing, our auditing process is designed to give you clear information, control, and confidence in the financial health of your medical practice.
CBS Medical Billing’s 4-Step Auditing Process:
Step 1: Initial Assessment and Discovery
We start by getting a clear picture of your current billing operations:
- How your office manages billing
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How your staff is structured
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Your current claim rejection rates
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The insurance payers you work with most frequently
This brief discovery phase sets the foundation for a focused, efficient audit.
Step 2: In-Depth Coding and Compliance Review
Our certified medical coders and compliance specialists dive deeper:
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We review samples of billing claims and electronic health records (EHRs)
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We identify billing errors, coding inaccuracies, and potential compliance risks
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We check alignment with payer-specific rules and industry standards
The goal: to uncover every area where clean claims and compliance can be strengthened.
Step 3: Comprehensive Reporting and Action Plan
After the review, we deliver an easy-to-understand audit report that:
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Highlights risks, vulnerabilities, and missed opportunities
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Pinpoints root causes of claim denials or payment delays
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Outlines clear, actionable steps to fix issues and optimize revenue cycle management
Our reports are designed to be practical—not overwhelming—so your team knows exactly where to start.
Step 4: Staff Training and Long-Term Support
Unlike other auditing services, CBS doesn’t just hand over a report and walk away.
We stay with you to:
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Train your staff on updated billing practices and compliance essentials
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Implement recommended improvements into your workflow
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Monitor performance to ensure the changes are sustainable
With CBS, auditing is the first step—lasting results are the real goal.
Why Choose CBS for Medical Billing Services?
Whether you’re a doctor working alone or a large group with many specialties, CBS’s Revenue Cycle Management services to manage your income process are designed to help you get 100% of your bills right and collect more money with fewer rejections.
➜ Specialized Medical Billing Experts
➜ 15 Years of Experience
➜ Custom Help For Practices of All Sizes
➜ Clear Reports & No Hidden Costs
➜ Dedicated People to Help You Personally
We work with many different types of doctors and medical practitioners, including family offices, natural health clinics, and specialists like our many clients in the O&P industry. Our goal? To get you the most money while giving you peace of mind.
“CBS is very knowledgeable and professional. I had the privileged of working with Ashley, Stacy and Erin. They work hard to scrub a claim and make sure it meets the criteria for medical necessity.”
— Brian Houchin
Ready To See What A Medical Billing Audit Can Show You About Your Practice?
Let CBS Medical Billing & Consulting guide you with knowledge, accuracy, and understanding. Contact us today for a free consultation and information about next steps for a Billing Audit or other Medical Billing Services.
Call us: (888) 510-4416 | Email us: info@cbsmedicalbilling.com
Partner with CBS Medical Billing & Consulting to protect your medical practice’s financial future – at CBS, we’re your practice’s missing piece!
