4 audits find thousands in lost revenue — how to capture payments you deserve

Why This Topic Matters

Revenue leakage can occur even when coding appears correct, so the article helps readers identify broad audit areas that may affect payment integrity and billing performance.

Article Sections

1. Audit No. 1: Check up on Medicare

   Discusses a Medicare-focused revenue audit and the broader process used to compare payment activity, claim documents, and payer records. The section emphasizes review of payment patterns and follow-up after discrepancies are found.

2. Audit No. 2: Verify changing policies on codes

   Covers an audit centered on changes to a CPT-related billing workflow and the impact of updated coding policy across payers. It also describes reviewing cases against supporting claim and remittance records.

3. Audit No. 3: Catch dropping revenue

   Addresses an audit prompted by declining revenue despite stable volume, with attention to payer mix, insurance master files, and denial trends. The section focuses on identifying data or workflow issues that can affect billing accuracy.

4. Audit No. 4: The million-dollar charge capture problem

   Describes a charge capture audit in a hospital-based setting and the process of identifying missed billable cases. The section highlights broad operational controls used to support complete case tracking.