Is an audit the same as a Compliance Analysis?

Medical Bill Audits & Compliance Analysis | Medical Bill & Coding Review


There are important differences.

Because a medical bill audit requires a detailed review of all medical records (almost always in person), an audit is costly and extremely time consuming. Most hospitals require a large percentage of the bill to be paid in advance of an audit, and the process ends in an agreement on-the-spot. The errors identified in an audit are based only on the question, “Was the service ordered and was it performed?”

A compliance analysis requires a detailed review of the UB-04 in combination with the detailed itemized statement. It’s performed prior to payment and conducted in-house with easy access to supporting documentation. The errors identified are based on federal regulations and billing guidelines. A Compliance Analysis is performed in a short time frame to meet the restricted reimbursement guidelines imposed on payers. The vast majority of medical billing errors and disputes can be identified and addressed with the Compliance Analysis process.


Here's how it works.

Compliance Analysis is a process that can be efficiently accomplished with our unique software, or sometimes by additional personal review of the software results. A forensic analysis of the summary bill, known as a UB04 claim form, and a forensic analysis of the detailed itemized statements breaks down each summary charge contained on the UB04. This analysis applies the federal compliance regulations and billing guidelines to each line item, identifying their level of compliance...identifying errors and flagging certain other line items for professional review.

We'll simply provide you with a detailed report of all charges that are ineligible for reimbursement, all before you have paid the bill. That means you and your team are empowered to pay only accurate charges from the get-go.