Service
Medical Billing Audit Services & Methodology
A diagnostic billing audit that reviews denials, AR aging, payer mix, eligibility errors, coding patterns, and workflow gaps — with prioritized recommendations you can act on.
Overview
What a billing audit covers.
A billing audit is a structured review of how claims move through your revenue cycle and where money is lost along the way. LRx Healthcare’s diagnostic audit looks at denials, A/R aging, payer mix, eligibility errors, coding patterns, and workflow gaps, and ends with a short, prioritized list of fixes — not a long report. It typically takes 5–10 business days from data hand-off.
This page explains what the audit covers and how it is done. The initial diagnostic audit is free and carries no obligation; to request one, go to the free billing audit page. Findings that point to a specific workflow often lead into denial management, A/R follow-up, or coding support — but you can act on them yourself.
Scope: The audit is operational, not a compliance investigation. It flags coding and documentation patterns that may carry audit exposure so you can address them, but it is not a formal compliance review or a legal opinion.
What you get
What’s included.
- Denial pattern and root-cause review
- AR aging and recovery opportunity analysis
- Payer mix and reimbursement gap review
- Eligibility and intake workflow review
- Prioritized recommendations and remediation plan
Outcomes
What better looks like.
- Clear visibility into revenue leakage
- Prioritized fix list, not a 40-page report
- Documented payer-by-payer issues
- A baseline you can measure progress against
How it works
Audit methodology, step by step.
- 1
Scoping call
A 20–30 minute call to agree which locations, providers, payers, and time period are in scope, and which problem you most want answered.
- 2
Data request
We ask for recent denial logs (90 days or more), A/R aging snapshots, a payer mix summary, and a sample of representative claims, shared through secure channels.
- 3
De-identified first
Most of the review can be completed with de-identified or aggregate data. A Business Associate Agreement is signed before any PHI is exchanged.
- 4
Denial analysis
Denials are grouped by payer, reason code, and provider to separate one-off problems from recurring ones.
- 5
A/R & payer review
A/R aging and payer-level payment behavior are reviewed to find stalled claims, slow payers, and underperforming reimbursement.
- 6
Front-end & coding review
Eligibility, authorization, and coding patterns are checked for the upstream errors that create denials.
- 7
Findings session
A working session walks through what we found, where the revenue is going, and what to do about it.
- 8
Prioritized plan
A short written summary ranks the fixes you can act on in the next 30, 60, and 90 days, with or without us.
What data is — and is not — needed
- Needed: denial logs or remittance detail covering at least 90 days
- Needed: an A/R aging report by payer
- Needed: a payer mix summary
- Helpful: a sample of representative claims and your fee schedule
- Not needed to start: patient-identifiable records — the review begins with de-identified or aggregate data
What you receive
- Denial pattern analysis by payer, reason, and provider
- A/R aging review and where recovery is still possible
- Payer mix and reimbursement gap findings
- Workflow gaps in eligibility, coding, submission, and posting
- A ranked fix list for the next 30, 60, and 90 days
Related services
Often paired with this service.
Most providers see the biggest gains when these workflows are operated together.
Billing Audit guides
Free guides on this topic.
Practical, answer-first guides from the LRx Healthcare revenue cycle team.
How to Reduce Claim Denials: A Prevention-First Guide
How to reduce claim denials: common CARC denial codes and fixes, root causes, a five-step prevention workflow, and the denial metrics to track monthly.
Read the guideMedical Coding Accuracy: Reduce Coding Denials Without Burning Out Coders
Improve medical coding accuracy: why coding denials happen, the ICD-10-CM, CPT, and HCPCS update calendar, modifier risks, and a coding audit program.
Read the guideHow to Choose a Medical Billing Company: 12 Questions to Ask Before You Sign
How to choose a medical billing company: 12 questions to ask, red flags to avoid, pricing models explained, and what should be in a medical billing contract.
Read the guideBilling Audit FAQ
Common questions about this service.
Quick, direct answers to the questions providers ask most about LRx Healthcare.
Let's get started
Ready to upgrade your billing audit workflow?
Request a free consultation or billing audit and we’ll walk you through where this service fits in your revenue cycle.