What Should a Free Medical Billing A/R Audit Review?

A comprehensive free medical billing A/R audit should review your aging buckets, top denial codes and root causes, payer mix and contract compliance, charge-capture workflows, and documentation gaps that delay payment. The goal is to identify leakage points and quantify dollars at risk without requiring you to change billing vendors or systems.

Why do practices request a free A/R audit?

Practices request a free A/R audit when collections slow, write-offs climb, or leadership suspects money is stuck in aging claims but lacks visibility into root causes. Common triggers include cash flow dropping month-over-month despite stable visit volume, days in A/R creeping upward, high denial rates with no clear pattern, staff turnover that left follow-up workflows incomplete, or transitions to a new EHR or payer contract.

A no-obligation audit gives you a snapshot of your revenue cycle health before you decide whether to add resources, retrain staff, or outsource. The review pinpoints which payers, codes, or workflows contribute most to aged balances, helping you prioritize fixes that deliver the fastest ROI.

What aging buckets does the audit analyze?

The audit breaks your A/R into aging bands—typically 0–30, 31–60, 61–90, 91–120, and 120+ days—then calculates the percentage and dollar value in each. Industry benchmarks suggest the majority of receivables should sit in the newest buckets, with older balances shrinking as follow-up intensifies. Claims beyond certain thresholds face timely filing limits and become harder to collect.

The audit flags which payers contribute most to aged balances and whether patterns point to eligibility errors, slow authorization processes, or missing documentation. By comparing your distribution to national benchmarks, you see at a glance whether aging is within normal range or requires immediate corrective action.

Which denial patterns does an A/R audit uncover?

The audit groups denials by reason code (CO-16, CO-50, CO-97, PR-1, etc.), payer, and service line to reveal whether denials stem from eligibility, coding, authorization, or billing errors. For example, CO-16 (missing information) points to incomplete claim forms or missing referral numbers; CO-50 (non-covered services) may indicate authorization lapses or incorrect billing codes; PR-1 (patient responsibility) suggests front-desk eligibility checks are weak.

By counting how often each code appears and tracking which staff or workflow step precedes it, the audit identifies the denial root causes worth fixing first. This data-driven approach lets you train staff on the errors that cost the most, rather than guessing.

Does the audit check payer mix and contract terms?

Yes, the audit compares your actual reimbursement rates to contracted fee schedules and calculates the percentage of revenue from Medicare, Medicaid, commercial payers, and self-pay. Findings often include underpayments where the remittance shows less than the contracted rate, high denial rates from a single payer suggesting credentialing or claim-format issues, self-pay balances sent to collections too late reducing recovery, and payers that consistently delay payment beyond contract terms.

This step ensures you're paid correctly for covered services and highlights payers whose denials or delays warrant focused follow-up or contract renegotiation. You may discover that a small number of payers account for a disproportionate share of aged or denied claims, signaling an opportunity to refine workflows or escalate issues to payer reps.

What charge-capture and documentation gaps appear in an audit?

The audit reviews superbills, encounter forms, and EHR workflows to spot missed charges, unbilled procedures, and documentation that doesn't support the level of service billed. Common gaps include procedures performed but not captured on the superbill, evaluation and management (E/M) levels downcoded by coders due to thin documentation, time-based codes missing start and stop times, modifier 25 appended without a distinct E/M note, and lab or diagnostic tests ordered but never billed.

Fixing charge-capture leaks can recover significant revenue per month without adding visits. The audit estimates the revenue at risk and recommends workflow changes or EHR templates to close the gap going forward.

How MB Claims handles this

MB Claims runs a complimentary A/R audit by pulling an anonymized aging report and a sample of recent denials from your practice management system. The review typically covers aging distribution and calculation of days in A/R, top denial codes by volume and dollar impact, payer performance including average payment time and denial rate per payer, charge-capture spot checks for common unbilled services, and a written summary with prioritized action steps. You receive a PDF or slide deck within one week. The audit does not require you to sign a contract, switch billing vendors, or grant system access beyond read-only reporting.

If you choose to move forward with medical billing or denial management support, the findings become your baseline for measuring improvement.

Frequently asked questions

How long does a free A/R audit take?

Most audits finish within one week after you provide an aging report and denial sample. The depth depends on how many claims and payers you want reviewed, but the turnaround is typically fast.

Do I have to switch billing companies to get an audit?

No. A free audit is a no-obligation review. You can keep your current billing team, bring findings to them, or use the report to compare vendors and decide next steps.

What data do I need to share for the audit?

Typically an A/R aging summary by payer, a list of recent denial codes, and optionally a sample of remittance advice. Patient names and Social Security numbers are not required for the review.

Will the audit tell me exactly how much revenue I'm losing?

The audit estimates dollars at risk in aging buckets, underpayments, and unbilled charges. Exact recovery depends on timely filing limits, payer policies, and whether claims can still be appealed or corrected.

Can an audit find issues my in-house team missed?

Yes. An outside review often catches denial patterns, contract variances, or workflow gaps that internal teams overlook due to daily workload or lack of benchmarking data against industry standards.

MB Claims · www.mbclaims.com · (888) 603-5358

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