Medical Billing Audit Services | Recover Revenue and Reduce Audit Risk
Transcure audits billing operations to find revenue that was never collected and exposure that has not been discovered yet. CMS put the FY2025 Medicare fee-for-service improper payment rate at 6.55%, or $28.83 billion, while Transcure clients hold clean claim accuracy at 99%. Our medical billing audit services deliver:
- Full review of coding, documentation, charge capture, and payer contract compliance
- AAPC and AHIMA-certified auditors validate every finding before it reaches your report
- Payer audit defense for RAC, TPE, UPIC, SMRC, and CERT record requests
- Medical billing audit services across 40+ specialties, each with its own risk profile
- First audit is free on engagements valued up to $2,000
Trusted by
500+ Physicians
Catering to
40+ Specialties
1100+ Certified
Medical Billers & Coders
End-to-End
RPA Billing Solutions
Up to 98% First Pass
Clean Claim Rate
Transcure's Medical Billing Audit Service Results
What Does a Transcure Medical Billing Audit Examine?
A billing audit is a diagnostic engagement, not a process. Our medical billing audit company reviews the full revenue surface rather than sampling claims in isolation:
Why Do Practices Get Audited and What Do Audits Find?
Most practices assume an audit follows a mistake. The record says otherwise, and the four exposures below apply whether or not a payer has contacted you.
Selection Is Frequently Random
The CERT program draws a stratified random sample of roughly 37,500 Medicare claims each reporting period. A practice does not need to have done anything wrong to be pulled into review.
Documentation Fails More Often Than Coding
Common findings include missing provider signatures, encounter notes that do not support every element of eligibility, and documentation that fails medical necessity. The code is frequently correct while the record behind it is not.
A Small Sample Becomes a Large Demand
Recovery Audit Contractors, UPICs, and MACs following a failed probe may extrapolate. An error rate found in 40 sampled claims gets projected across the full population, which turns a modest finding into a six-figure repayment demand.
Health Plan Pressure Reaches Providers
CMS expanded Risk Adjustment Data Validation audits from roughly 60 Medicare Advantage contracts per year to all eligible contracts, and raised its coder headcount from 40 to about 2,000. Plans absorb that pressure by requesting far more records from providers.
How Does Transcure Defend RAC, TPE, and UPIC Audits?
An audit letter arrives with a clock already running. The table below shows who is contacting you, why, and how long you have.
Appeals for aged claims get auto-drafted using payer-specific rules and supporting documentation. Paired with DEXA, ARIA drives an auto-resolution rate of over 80% on stuck claims, with no manual triage required. Accounts that once sat untouched past 90 days now move toward resolution automatically.
Two details change how a practice should respond. The clock runs from the date printed on the letter rather than the date your office received it. A 30-day window signals a program integrity review rather than a routine one.
Escalation is the larger risk. Three failed TPE rounds can trigger 100% prepayment review, authorized extrapolation, or referral to a Recovery Audit Contractor. A UPIC that develops evidence of fraud moves the matter to the OIG or the Department of Justice. Findings left unremediated after a prior audit support the knowledge standard under the False Claims Act. That is how a billing problem becomes a fraud exposure.
Contractor
MAC
TPE
RAC
SMRC
CERT
UPIC
What Triggers It
Routine or targeted review
High error rate or unusual billing
Improper payment identification
Nationwide review of a service category
Random statistical sample
Suspected fraud, waste, or abuse
Response Deadline
45 days
45 days
45 days
45 days
45 days
30 days
May Extrapolate
After TPE failure
After three failed rounds
Under defined conditions
Varies by review
No
Yes
What Do You Receive in the Audit Report?
Every audit closes with a written report rather than a verbal summary. The report quantifies what was found, traces each finding to its source, and ranks remediation by dollar impact.
Exposure gets stated plainly, including overpayment items subject to the 60-day repayment rule and any indicators that would support extrapolation during a payer review. Nothing gets softened, because a finding you did not understand is a finding you will repeat.
What We Found
- Claims reviewed and total flagged
- Error rate by category
- Dollar exposure per finding
Where It Came From
- Accuracy by provider
- Accuracy by coder
- Findings by payer
What To Fix First
- Findings ranked by dollar impact
- Remediation step per finding
- Documentation templates included
What You Are Exposed To
- Overpayments under the 60-day rule
- Extrapolation risk indicators
- Payer audit readiness status
What Does the Free Medical Billing Audit Include?
Transcure covers the first audit on engagements valued up to $2,000. Larger reviews get quoted before any work begins.
Factor
Engagement value
Cadence
Findings report
Remediation of findings
Payer audit defense
Appeal and rebuttal support
Pricing
Free First Audit
Up to $2,000
One time
Included
Not included
Not included
Not included
No cost
Ongoing Audit Program
Quoted by scope
Monthly or quarterly
Included
Included
Included
Included
Under the 5% collections fee
What Types of Medical Billing Audits Does Transcure Perform?
Audits differ by when they happen and who initiates them, and each type answers a different question.
Prospective Audits Before Submission
Claims get reviewed before they leave your system. This audit type prevents denials and improper payments at the source rather than correcting them after adjudication.
Retrospective Audits After Payment
Paid claims get reviewed to quantify what was collected incorrectly in both directions. Retrospective medical claims audit work surfaces underpayments you can recover and overpayments you must address.
Payer-Initiated Audit Response
A contractor requests records and a deadline starts running. Transcure assembles the response, builds the rebuttal, and manages the appeal through final determination.
How Does Transcure Run a Medical Billing Audit?
The engine that prevents billing errors is the same engine that finds them. CODIN runs its coding and compliance rule libraries against your historical claims rather than your pending ones, flagging assignments that documentation does not support. DEXA supplies denial history, which converts isolated findings into identified patterns.
Findings surface inside Transcure’s Master Command Dashboard as the audit progresses, so nothing waits for a final report. AAPC-certified auditors validate every flag before it reaches you, because an automated finding is a starting point rather than a conclusion. Complex cases route to manual review instead of automatic inclusion.
Why Choose Transcure for Outsourced Medical Billing Audit Services?
Transcure delivers medical billing audit solutions that quantify exposure and then remove it. Below are the key reasons practices rely on Transcure for medical billing audit services rather than other medical billing audit companies:
Findings Tied to Remediation
Most audit vendors deliver a report and leave. Transcure corrects the workflow that produced each finding, so the same error does not appear in next year’s audit.
Payer Audit Defense Included
RAC, TPE, UPIC, and SMRC responses come under the same engagement rather than a separate retainer. Certified auditors build the rebuttal and manage the appeal to final determination.
Full Claim History, Not a Sample
Automated review covers your complete claim history instead of a statistically selected subset. Exposure that a sample would miss gets identified before a contractor finds it.
Specialty-Specific Audit Targets
Audit risk varies sharply by claim type, with durable medical equipment at a 24.12% improper payment rate against 8.44% for Part B. Auditors trained in your specialty know where that risk sits.
Real-Time Audit Dashboard
Transcure’s Master Command Dashboard shows live findings, exposure totals, and remediation status. Your practice manager reviews audit progress at any hour, any day.
HIPAA-Compliant Record Handling
An audit moves clinical records and payer correspondence across multiple systems. Transcure protects that data with HIPAA-compliant encryption and SOC-1 and SOC-2 certified processes.
Our Certifications
Transcure’s nephrology billing team holds industry-recognized certifications to make sure that renal claims meet CMS compliance standards and payer-specific coding requirements.
Medical Billing Audit Services for 40+ Specialties
Audit targets change from one specialty to the next, and CMS improper payment rates confirm it. Transcure runs medical billing audits inside 40+ specialty billing programs, each staffed by auditors trained in that specialty’s documentation and payer rules.
What Other Revenue Cycle Management Services Does Transcure Offer?
Beyond auditing, Transcure provides a complete range of revenue cycle management services covering every stage of the billing process. Here are the other RCM services our team offers:
What Results Have Transcure's Audit Clients Seen?
Audit findings only matter once they turn into collected revenue. Here is what recovery looked like for practices that acted on their audit report.
Innovative Pain Care Center
The Challenge
The Solution
Transcure took over end-to-end billing, providing claim audits, denial prevention, and AI agent-driven follow-ups. In 60 days, we recovered $3M and brought days in A/R below 35.
Client Review
“Transcure gave us back control of our cash flow and the ability to grow. We needed expertise we just didn’t have in-house, and they delivered.”
Dr. Daniel Burkhead
CSO, Innovative Pain Care Center
Key Achievements
AR Recovered
Collections Boost
AR Turnaround
Days in A/R
Idaho Kidney Institute
The Challenge
IKI was carrying $300K stuck in the 60+ day bucket, denials from missing info, self-pay misrouting, medical necessity rejections, and invalid ICD/modifier usage.
The Solution
We ran targeted appeals, rigorous eligibility verification, and a complete coding clean-up. Within 90 days, the backlog dropped to $100K, and denial rates fell sharply.
Client Review
“The transformation we’ve experienced with Transcure is nothing short of astounding. They didn’t just tackle our billing — they educated our team.”
Dr. Fahim Rahim
Idaho Kidney Institute
Key Achievements
Backlog Cleared
Turnaround
Denial Reduction
Eligibility Checks
MD TruCare PA
The Challenge
MD TruCare’s psychiatry practice was losing revenue to late submissions, duplicate payment posting, and coding inefficiencies, burning staff time on repetitive billing tasks.
The Solution
Transcure deployed Robotic Process Automation across the billing workflow. Bots scrubbed claims, accelerated clean submissions, and freed staff to refocus on patient care.
Client Review
“Our clinical performance improved significantly, and our daily operations became 40% more efficient with Transcure’s RPA implementation.”
Dr. Imran S. Khawaja
CEO, MD TruCare PA
Key Achievements
Op. Efficiency
Collections Growth
Denial Reduction
Claim Acceptance
Trusted by Thousands Across the Nation
Our results speak for themselves, as we are consistently rated top-tier Account Receivable company by clients on every major review platform.
Frequently Asked Questions About Medical Billing Audit Services
How Often Should a Practice Run a Billing Audit?
Most practices benefit from a quarterly review, with annual audits as the minimum for low-volume specialties. Practices carrying prior audit findings or high denial rates should audit monthly until findings close.
What Is the Difference Between a Billing Audit and a Coding Audit?
A coding audit examines whether CPT, ICD-10, and HCPCS assignments match the documentation. A billing audit covers that plus charge capture, contract compliance, denial patterns, accounts receivable, and front-end intake accuracy.
What Happens If the Audit Finds an Overpayment?
Identified overpayments must be reported and returned, generally within 60 days of identification under federal rules. Transcure quantifies the exposure, prepares the disclosure, and corrects the process that caused it.
Can Transcure Respond to a RAC or UPIC Audit Already in Progress?
Yes, Transcure takes over active audit responses at any stage before the deadline passes. Certified auditors assemble the records, draft the rebuttal, and manage the appeal through final determination.
Is the Free Audit Really Free?
Yes, Transcure covers the first audit on engagements valued up to $2,000. Reviews that exceed that scope get quoted in advance, and no work begins without your approval.
Is There a Long-Term Contract Required?
No, Transcure does not require a long-term lock-in for medical billing audit services. Ongoing audit work is billed under the standard 5% collections fee, with specific contract terms confirmed during onboarding.
Can Transcure Audit Billing Inside Our Existing EHR?
Yes, Transcure audits inside 43+ EHRs, including Epic, Athenahealth, eClinicalWorks, AdvancedMD, and NextGen, so records never leave your system for review.