Medical Billing & Coding Audits That Find What Payers Would, First
One wrong E/M level or modifier, repeated across a year of claims, becomes either lost revenue or a refund demand. Arizona Billing Services' certified auditors review your charts, codes and claims, score your accuracy and show you exactly what to fix, before Medicare, AHCCCS or a commercial payer does it for you.
- Free 10-chart audit with a scored report in 5 business days
- Coding and billing reviewed together: CPT, ICD-10-CM, HCPCS, modifiers, charges and payments
- Provider-by-provider feedback and a re-audit in 90 days
- 8+ years serving Arizona practices
- Certified coding auditors
- 60+ specialties
- HIPAA compliant, BAA before access
What Is a Medical Billing and Coding Audit?
A medical billing and coding audit is an independent review of a sample of claims against the clinical documentation, coding guidelines and payer rules behind them. It checks that every billed code is supported, every supported service is billed, and every payment matches what you should have received.
A coding audit asks: "Was this coded correctly from the note?" A billing audit asks: "Was it billed, paid and posted correctly?" Arizona Billing audits both, because errors on either side cost the same money.
The Cost of Not Auditing Is Higher Than Ever
Errors are common, even without fraud
Medicare's Comprehensive Error Rate Testing (CERT) program reported a fiscal year 2025 fee-for-service improper payment rate of 6.55%, driven largely by documentation and coding errors.
Payers extrapolate
When an auditor finds an error rate in a sample, it can be applied to every similar claim you billed, turning a few wrong codes into a large refund demand.
You have 60 days
Once you identify a Medicare overpayment, federal rules require you to report and return it within 60 days.
Lookbacks are long
Medicare Recovery Audit Contractors can review claims up to 3 years back.
Undercoding costs too
Many practices code conservatively to stay safe and lose revenue on every visit. An audit shows where you are leaving money behind.
7 Signs Your Practice Needs an Audit Now
Your denial rate is above 5% and the same denial reasons keep repeating.
Your E/M level distribution looks very different from your specialty's peers.
You've added providers, coders or a new EHR in the last 12 months.
A payer has sent a records request, a TPE notice or a prepayment review letter.
Collections dropped and no one can explain why.
You haven't had an independent audit in over a year.
You see Medicare Advantage patients and have never audited HCC capture.
Every Part of the Claim, Audited in One Review
Coding Accuracy: CPT, ICD-10-CM and HCPCS
Every code is checked against the note, with ICD-10-CM specificity, CPT and HCPCS selection, units and NCCI edit compliance.
E/M Leveling Under Current Guidelines
Office and other-setting visits are leveled by medical decision making or total time under the 2021 and 2023 E/M guidelines, with split/shared and modifier 25 use reviewed.
Modifier Use: 25, 59, X{EPSU}, 24, 57 and More
Modifiers are the most common audit target. We check each one is justified by the documentation, not added to get past an edit.
Documentation and Medical Necessity
Notes are reviewed for signatures, time statements, orders and medical necessity under the applicable LCDs and NCDs.
Charge Capture and Fee Schedules
We compare what was documented with what was billed to find missed charges, and check that your fee schedule is not set below payer allowables.
Payment Variance and Underpayments
Allowed amounts are compared to your payer contracts to find claims that were paid, but paid short.
Denial Root Causes
Denials in the sample are traced back to the coding, documentation or front-end step that caused them.
Risk Adjustment (HCC/RAF) Audits
For Medicare Advantage panels, we check that chronic conditions are captured and supported with MEAT documentation, so RAF scores are accurate in both directions.
Choose the Audit That Fits Your Risk
| Audit type | What it covers | Best for |
|---|---|---|
| Baseline (comprehensive) | 10 random charts per provider across all services | First audit, new partnership, annual check |
| Focused | 20–30 charts on one provider, code family, payer or denial reason | A known problem or a payer's records request |
| Prospective (pre-bill) | Claims reviewed before submission | New providers, high-risk procedures, practices under prepayment review |
| Retrospective (post-payment) | Claims already paid | Finding overpayments and underpayments |
| Risk adjustment (HCC) | Medicare Advantage encounters and diagnoses | Practices with MA panels |
| Follow-up | Re-audit 90 days after education | Proving that fixes worked |
From Kickoff to Findings in 2–3 Weeks
Scope and sign the BAA (Day 1–2)
We agree on providers, date range, audit type and sample size, and sign a Business Associate Agreement before any data is shared.
Select the sample (Day 3)
Charts are drawn at random or targeted on high-risk codes, so the findings represent your real billing.
Audit charts and claims (Days 4–12)
Certified auditors code each chart blind, then compare our codes to what was billed and paid.
Score and validate (Days 13–14)
Each finding is scored and checked by a second auditor before it goes into your report.
Review and educate (Week 3)
We walk you and each provider through the findings, then schedule a re-audit for 90 days later.
Know Your Accuracy Score, Not Just a List of Errors
Every audit produces two numbers. Claim-level accuracy is the share of claims with no errors at all. Line-level accuracy is the share of individual codes, modifiers and units that were correct. Each error is classified as an overcode, undercode, missed charge, wrong modifier or unsupported diagnosis, and given a dollar value.
The industry benchmark is 95% accuracy or higher. Scores between 90% and 95% call for targeted education. Below 90%, we recommend an expanded review and consider whether overpayments need to be reported and refunded.
A Report You Can Act On the Same Day
Overall and provider-by-provider accuracy scores
An error log with the billed code, the correct code and the documentation behind each finding
Financial impact: revenue missed and potential overpayment exposure
Root causes grouped by provider, code family, payer and denial reason
E/M distribution compared with specialty norms
A prioritized corrective action plan, with the fixes that matter most first
Provider and coder education notes, plus a 90-day re-audit date
Ready for Arizona's Payer Audits
Arizona practices face audits from several directions. The AHCCCS Office of Inspector General reviews Medicaid claims and recovers overpayments. Noridian, Arizona's Medicare contractor, runs Targeted Probe and Educate (TPE) reviews, alongside CERT and RAC reviews. Medicare Advantage plans, a large share of Arizona's Medicare market, audit diagnosis coding through risk-adjustment data validation. Our audits test your claims against the same rules these reviewers use, and if a records request has already arrived, we help you prepare the response.
Certified Auditors With 8+ Years in Arizona and 60+ Specialties
Arizona Billing Services is an Arizona medical billing and credentialing company with more than 8 years in the field. Our certified, dedicated team understands the revenue cycle across 60+ specialties, so your charts are reviewed by auditors who know your specialty's codes, modifiers and payer policies. Audits are independent: we review your charts on their merits, whether or not we handle your billing.
How Often Should You Audit? A Simple Guide
| Situation | Recommended frequency |
|---|---|
| Established providers, stable accuracy above 95% | Once a year |
| New providers or coders | Prospective review for the first 30–60 days, then quarterly for the first year |
| Accuracy below 95% or a recent payer audit | Quarterly until two audits in a row score above 95% |
| New service line, EHR or major coding update | Focused audit within 90 days |
| Medicare Advantage panels | HCC audit once a year, before the risk-adjustment submission deadline |
Fixed-Price Audits, Quoted Before We Start
Audit pricing in the industry is usually set per chart or per provider. A focused or baseline audit of 10 charts per provider typically runs a few hundred dollars per provider, with larger or risk-adjustment audits priced by scope. Arizona Billing Services gives you a fixed written quote after the scoping call, and your first 10-chart audit is free.
Specialty-Specific Audits for 60+ Specialties
Each specialty has its own audit risks: E/M and modifier 25 in primary and urgent care, procedure and imaging bundling in cardiology and radiology, time-based psychotherapy codes in mental health, debridement depth and frequency in wound care, lesion and Mohs coding in dermatology, drug units in oncology, and medical-necessity limits in chiropractic.
We audit for practices in Phoenix, Tucson, Mesa, Scottsdale, Chandler, Gilbert, Glendale, Flagstaff and across Arizona.
From Findings to Fixes Across Your Revenue Cycle
An audit is only worth what you fix afterward. Coding findings feed our medical coding team and your provider education. Denial patterns go to denial management, and recoverable underpayments go to A/R follow-up. Enrollment and taxonomy errors are corrected by our credentialing team. For ongoing protection, see full revenue cycle management.
Billing and Coding Audit Questions Arizona Practices Ask Us
Find Out What 10 of Your Charts Reveal, Free
Within 5 business days of receiving 10 charts and their claims, Arizona Billing Services sends you:
- Your claim-level and line-level accuracy scores
- Every error found, with the correct code and dollar impact
- Your top 3 risk areas and how to fix them
- A recommendation on whether you need a fuller audit
No cost, no obligation, and your findings stay confidential. We sign a BAA before we see any patient data.
Call (631) 652-3106 · Mon–Fri, 8:00 a.m.–5:00 p.m. MST