Practice & Billing Audits

We review a representative sample of your coding and documentation, analyze claim and denial patterns, and assess compliance risk across your revenue workflows. The deliverable is a prioritized findings report with a concrete remediation plan, so you know where revenue is leaking, where audit exposure exists, and what to fix first. It is an independent, objective baseline rather than a sales pitch for taking over your billing.

We select a representative sample across your high-volume codes, top payers, and the areas most prone to error, such as modifier usage, units, and medical-necessity documentation. We also look at denial and adjustment patterns to target where dollars are most likely slipping. The goal is a sample meaningful enough to reveal systemic issues without disrupting your team or requiring a full chart-by-chart review.

Yes. We execute a Business Associate Agreement before any protected health information changes hands, and we work under HIPAA safeguards throughout. We access the minimum necessary records for the sample, typically inside your existing EHR or PM system, and findings are shared through secure channels. Nothing about the audit requires loosening your access controls.

Yes. We work as an extension of your office inside your existing EHR, practice-management, and clearinghouse tools rather than asking you to export data into ours. That keeps the review grounded in the same documentation, edits, and remittance detail your team sees every day. Read access to the relevant records is usually all we need to complete the audit.

Yes. DME is a core area for us, so an audit can dig into HCPCS coding, modifier accuracy, capped-rental tracking, standard written orders, proof of delivery, and medical-necessity documentation against the applicable LCDs. For home health we can review OASIS coding, PDGM grouping logic, and RAP and timely-filing exposure. The audit scope is shaped to the rules that actually drive your payer mix.

We do not publish flat pricing because the right scope depends on your specialty, claim volume, payer mix, and how deep you want the review to go. After a short consult to understand those factors, we scope the audit and give you a clear price before any work begins. There are no surprise charges beyond the agreed scope.

You receive a written report that documents each finding, its dollar or compliance impact, and where it sits in your workflow, with issues ranked so you can act on the highest-impact items first. We pair that with a remediation plan that spells out what to change in coding, documentation, or process. The report is meant to be acted on, not just filed.

An audit is most useful when it is independent of the people doing the daily billing, because an internal or incumbent self-review carries an inherent conflict of interest. Since NextRCM conducts the review as an outside party, we have no stake in overlooking patterns the existing process may have introduced, which makes it a cleaner baseline before you change partners or scale. You get an honest read on where you stand, with no requirement to move your billing to us.