Billing & Revenue Cycle Audits FAQ
Reducing Denials, Protecting Compliance, And Ensuring Revenue Integrity
1. What is a billing process audit?
A billing process audit is a comprehensive review of your end-to-end revenue cycle to evaluate accuracy, compliance, and efficiency. It examines every step, from patient registration and charge capture to coding, claim submission, payment posting, and denial management.
The goal is to uncover leakage points, inefficiencies, and compliance risks that affect reimbursement and cash flow.
2. How is a billing process audit different from a coding audit?
- Coding Audit: Focuses specifically on clinical documentation and code accuracy (CPT, ICD-10, HCPCS).
- Billing Process Audit: Goes beyond coding to analyze operational workflows, payer requirements, claim processing, and financial controls across the full revenue cycle.
Together, they ensure both compliance and financial integrity.
3. What is revenue cycle analysis?
Revenue cycle analysis involves using data-driven insights and KPIs to measure financial health. It identifies trends, benchmarks performance, and highlights systemic issues such as:
- High denial rates
- Delayed days in accounts receivable (AR)
- Low clean claim rates
- Underpayments or missed charges
- Provider/payer-specific reimbursement trends
This empowers organizations to make strategic improvements that drive sustainable revenue growth.
4. What are the key benefits of a billing process audit and revenue cycle analysis?
- Revenue Integrity: Capture missed charges, prevent undercoding, and identify leakage.
- Compliance Assurance: Ensure adherence to payer rules and CMS regulations.
- Denial Reduction: Address root causes of denials to increase clean claim rates.
- Cash Flow Optimization: Shorten AR days and accelerate reimbursement.
- Operational Efficiency: Streamline workflows and reduce manual rework.
- Benchmarking: Compare practice performance against national standards.
5. What areas does TriumpHealth assess during an audit?
TriumpHealth’s billing process audits evaluate:
- Front-End Processes: Eligibility verification, prior authorizations, patient demographics.
- Charge Capture & Coding: Accuracy, completeness, and documentation compliance.
- Claims Submission: Timeliness, payer-specific requirements, error rates.
- Payment Posting: Accuracy of payments, adjustments, and contractual allowances.
- Denials & Appeals: Denial reasons, appeal effectiveness, resubmission trends.
- Reporting & Analytics: KPI dashboards for actionable insights.
6. How often should practices conduct billing audits?
- Annually as a baseline.
- Quarterly or semi-annually for high-volume practices, multi-specialty groups, or those with persistent denial issues.
- Immediately after system changes (new EHR, billing software, or payer contract updates).
Regular reviews ensure practices stay compliant, proactive, and financially healthy.
7. What deliverables can I expect from TriumpHealth’s audit?
- Comprehensive Audit Report highlighting gaps, risks, and opportunities.
- Root Cause Analysis of denials, AR delays, and underpayments.
- Benchmarking Data comparing KPIs against industry standards.
- Revenue Recovery Forecasts estimating financial impact.
- Actionable Roadmap for workflow improvements, training, and process redesign.
8. How do audit insights translate into real financial gains?
Audit findings lead to measurable improvements such as:
- Reduced denial rates (often by 15–25%)
- Increased reimbursement capture (up to 10–20%)
- Shortened AR cycles
- Improved compliance scores during payer or CMS audits
- Enhanced provider satisfaction through reduced rework
9. Who performs TriumpHealth’s billing process audits?
Our audits are performed by RCM experts, certified coders, and financial analysts with deep experience across specialties, facilities, and multi-state payer landscapes.
10. What types of organizations benefit most?
- Solo providers and specialty practices
- Multi-site physician groups
- Federally Qualified Health Centers (FQHCs)
- Ambulatory Surgical Centers (ASCs)
- Hospitals and healthcare systems
Any organization that bills for healthcare services can benefit from greater billing accuracy, revenue integrity, and compliance confidence.
11. Why partner with TriumpHealth for audits and analysis?
TriumpHealth combines technical coding expertise, payer policy knowledge, and advanced analytics to deliver audits that not only identify problems but also provide strategic solutions. Our services are designed to help practices scale, remain compliant, and maximize financial performance.
Ready to uncover hidden revenue and streamline your billing processes? Schedule A Consultation for a detailed billing process audit and revenue cycle analysis. You can also contact us via email [email protected] or call (888) 747-3836 x0.
Disclaimer:
The content provided by TriumpHealth is for informational purposes only and does not constitute legal, medical, or financial advice. Regulations and payer requirements may change; please consult a qualified professional for guidance specific to your situation. Click here to review our full legal disclaimer.
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