Medical Audit
Ensuring accurate reimbursements and compliance with payer policies
At SkyShine Health Solutions, our Medical Audit Services ensure your practice remains compliant, financially optimized, and prepared for regulatory scrutiny. As a premier medical billing company, we provide comprehensive audit solutions for solo practitioners, multi-specialty clinics, and large healthcare facilities. Leveraging advanced analytics and deep industry expertise, we identify compliance risks, coding inaccuracies, and revenue opportunities, empowering your practice to operate with confidence and efficiency.
We offer tailored audit solutions to meet the needs of all healthcare specialties, including primary care, specialty practices, and ancillary services. Our services integrate seamlessly with your existing EHR/EMR systems for accurate, efficient auditing.
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Our Medical Audit Services
Coding and Documentation Audits
We review your coding and documentation practices to ensure accuracy and compliance with industry standards.
What We Audit:
ICD-10, CPT, and HCPCS code accuracy
Evaluation and Management (E/M) documentation
Medical necessity and modifier usage
Our audits improve coding accuracy by up to 25%, reducing denial risks.
Compliance Audits
We ensure your practice adheres to federal and payer-specific regulations to avoid penalties and audits.
Key Areas:
HIPAA and OSHA compliance
Medicare and Medicaid billing requirements
MIPS and quality reporting standards
Our compliance audits achieve 100% audit readiness for clients.
Payer Audit Preparation
We prepare your practice for external payer audits, minimizing disruptions and financial impact.
Our Process:
Mock audits to simulate payer reviews
Identification and correction of high-risk areas
Documentation training for audit defense
Clients reduce payer audit penalties by 40% with our proactive preparation.
Revenue Recovery Audits
We identify underpayments and missed billing opportunities to recover lost revenue.
What We Review:
Audit Focus | Outcome |
|---|---|
Underpaid Claims | Recover 10-15% of missed reimbursements |
Denied Claims | Appeal and recover 90% of eligible denials |
Unbilled Services | Identify and bill for undocumented procedures |
Our revenue recovery audits boost collections by up to 20%.
Risk Assessment and Mitigation
We conduct risk assessments to identify vulnerabilities and implement corrective action plans.
Risk Areas:
Upcoding or undercoding patterns
Non-compliant billing practices
Documentation gaps impacting medical necessity
Our mitigation strategies reduce audit risks by 30%.
Custom Audit Reports
Our advanced analytics provide detailed, actionable reports to guide your practice’s improvement.
Report Features:
Coding error trends and correction recommendations
Compliance status and risk scores
Revenue impact analysis with recovery projections
These reports empower data-driven decisions for operational and financial success.
Lets experience our medical billing services
Over 500+ medical practices trust Skyshine Health Solutions medical billing services company. So let’s have a chat.
Patient's insurance coverage verification on the spot.
HIPAA-compliant medical billing services for data safety.
24/7 medical billing services to handle every claim submission.
98% claim reimbursement rate for healthy cash flow.
Why You Should Choose Us?
Our medical billing experts dive deep into your healthcare RCM procedures with the aim of earning clients’ satisfaction as a result. With this vision, we offer the most cost-effective, highly efficient and reliable medical billing solutions to our clients.
From patient eligibility verification to claim submission, our expert medical billing specialists pay attention to fine details in practice management. We make sure that your hard-earned income never slips through the loopholes.
We empower healthcare practices with robust support and insightful medical billing services. We ensure 100% accuracy through our professional healthcare RCM services to claim payments. We boost revenue with precise, efficient billing services.