How to Audit Your Medical Billing Company’s Work

In today’s healthcare environment, where margins are tighter and regulations more complex, entrusting your billing operations to a medical billing company is a strategic decision. However, outsourcing doesn't mean disconnecting. Regularly auditing your billing partner’s work ensures accountability, performance, and alignment with your practice's financial goals.

Even the most trusted partners benefit from periodic evaluation. That’s why practices working with companies like Thrive Medical Billing not only expect outstanding service — they also verify it through transparent audits and performance checks. In this article, we’ll guide you step-by-step on how to audit your medical billing company’s work and what metrics matter most to your practice.

Why Auditing Your Medical Billing Company Is Important

Outsourcing your billing process doesn’t mean giving up control. It means trusting professionals to manage your revenue cycle while maintaining transparency and performance. Here are the core reasons to audit your billing company:

• Ensure financial accuracy

• Identify inefficiencies or billing errors

• Validate compliance with HIPAA and payer rules

• Track revenue performance against benchmarks

• Hold your billing partner accountable

Thrive Medical Billing encourages regular performance reviews with its clients because transparency builds trust and provides opportunities to improve results over time.

Step 1: Define the Scope of Your Audit

Before diving into the numbers, define what aspects of the billing process you want to audit. The audit could be comprehensive or focused on specific areas. Common audit scopes include:

• Claims submission and denial management

• Accounts receivable aging

• Payment posting accuracy

• Coding accuracy and compliance

• Patient billing and collection

• Timeliness of claim submissions

• Communication and customer service quality

By clarifying the scope, you can ensure the audit is structured, efficient, and aligned with your practice’s goals.

Step 2: Gather Necessary Reports and Documentation

To properly audit your medical billing company, you’ll need access to a variety of reports and source documents. A professional partner like Thrive Medical Billing will be able to provide the following on request:

• Claims submission logs

• Denied and rejected claims reports

• Accounts receivable (A/R) aging reports

• Payment reports by payer and procedure

• Coding and charge entry reports

• EOBs (Explanation of Benefits) from payers

• Patient billing statements

• Monthly revenue cycle summary

These documents provide a comprehensive view of how billing is being handled and where potential issues might be occurring.

Step 3: Review Claims Submission and Timeliness

Timely claim submission is key to maintaining consistent revenue flow. During your audit, ask:

• Are claims being submitted within 24–72 hours of the date of service?

• Are claims submitted electronically or manually?

• How often are claims delayed, and why?

A top-tier medical billing company like Thrive Medical Billing typically submits claims within 1–2 business days using automated, real-time systems, reducing delays and errors.

Step 4: Evaluate Denial Management

Denied claims can significantly affect your cash flow if not addressed promptly. Use the following questions to assess this area:

• What is the denial rate (should be under 10%)?

• Are denials tracked and categorized by reason?

• How quickly are denied claims resubmitted or appealed?

• Are there recurring patterns in denials?

Thrive Medical Billing uses proactive denial tracking tools and payer-specific analytics to resolve issues quickly and prevent future errors.

Step 5: Check Coding Accuracy and Compliance

Incorrect coding is one of the main causes of claim denials and compliance violations. When auditing coding practices, review:

• Are diagnosis and procedure codes aligned with documentation?

• Is the billing company using the latest CPT, ICD-10, and HCPCS codes?

• Are claims coded up-to-date with payer-specific guidelines?

• Are certified coders reviewing claims?

With Thrive Medical Billing, certified professional coders ensure compliance with evolving coding standards and help reduce audit risks for your practice.

Step 6: Analyze A/R Aging and Collections

Accounts receivable (A/R) aging reports show how quickly your practice is collecting its revenue. In your audit, look for:

• Total A/R outstanding

• Percentage of A/R over 30, 60, and 90+ days

• Collection success rate from insurance and patients

• Efforts made to follow up on old claims

Industry benchmarks suggest that no more than 25% of A/R should be over 90 days. If yours exceeds that, your medical billing company may not be following up effectively.

Thrive Medical Billing consistently maintains A/R below the industry average by implementing aggressive but ethical collection strategies and diligent follow-ups.

Step 7: Verify Payment Posting Accuracy

Timely and accurate payment posting ensures your reports reflect reality and helps prevent duplicate billing. Confirm:

• Are payments posted daily?

• Are adjustments and contractual write-offs applied correctly?

• Are discrepancies between payments and expected reimbursements documented?

Accurate payment posting is a routine practice at Thrive Medical Billing, supported by real-time financial tracking tools.

Step 8: Review Patient Billing and Collections

Patient financial responsibility is increasing, and billing transparency matters more than ever. During the audit, evaluate:

• Are patient statements accurate and easy to understand?

• How long after the visit are statements sent?

• Are payment options convenient (online, mobile, in-person)?

• Is there a process for handling billing disputes?

Thrive Medical Billing enhances the patient experience by offering multi-channel billing, payment portals, and compassionate follow-up methods that improve patient satisfaction and collections.

Step 9: Measure Against Industry Benchmarks

Benchmarking your billing data against national standards will help identify gaps. Key performance indicators (KPIs) include:

If your results fall short, it may be time to work closely with your billing partner to improve — or consider switching to a more performance-driven medical billing company like Thrive Medical Billing.

Step 10: Conduct Performance Review Meetings

After analyzing the audit data, schedule a performance review meeting with your billing partner. In this meeting:

• Discuss areas of strength and concern

• Ask for a corrective action plan if necessary

• Set specific improvement goals

• Confirm timelines and accountability

• Evaluate the quality of client service and responsiveness

Thrive Medical Billing conducts regular client reviews with full transparency and collaborates closely on strategies for continual growth.

Red Flags to Watch For

During the audit process, certain red flags may signal deeper issues:

• Frequent, unexplained claim denials

• Slow or incomplete responses from the billing company

• High A/R over 90 days

• Inadequate or missing reports

• Lack of visibility into metrics and performance

If these issues are ongoing despite feedback and correction efforts, it may be time to switch to a more capable and reliable medical billing company.

Why Choose Thrive Medical Billing?

Thrive Medical Billing stands out in the industry for its dedication to transparency, accuracy, and client growth. What makes them a trusted choice?

• Certified billing and coding experts

• Fast and accurate claim submissions

• Custom reporting dashboards

• Proactive denial management

• HIPAA-compliant, secure systems

• Dedicated account managers for real-time support

Most importantly, Thrive Medical Billing welcomes audits. They believe that measurable performance, open communication, and continuous improvement are the foundation of successful long-term partnerships.

Conclusion

Auditing your medical billing company is not just a smart financial decision — it’s a strategic necessity. Regular audits ensure your billing partner is delivering value, maintaining compliance, and supporting your goals. With a structured approach, you can identify gaps, boost revenue, and enhance patient satisfaction.

Whether you're already working with a billing partner or exploring your options, remember: the right medical billing company doesn’t just process claims — it helps your practice grow. If you're looking for a partner that thrives on transparency, precision, and results, Thrive Medical Billing is ready to exceed your expectations.