How do you audit a medical billing company?
Auditing a medical billing company in 2026 involves regular review of key performance metrics such as net collection rates, first-pass acceptance percentages, denial rates and recovery success, average AR days, and aging reports to confirm claims are being pursued aggressively. Compare these against industry benchmarks and your pre-transition baseline. In my experience, request sample claim audits, denial logs, and payer correspondence to verify accuracy and timeliness. My advice is to include audit rights in your contract and perform formal reviews at least quarterly. Consistent shortfalls in these metrics indicate problems that require immediate attention and correction.
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Compare Medical Billing OptionsMedical billing questions practices often ask too late
Medical billing questions tend to increase once practices move beyond basic claim submission. Billing accuracy depends on documentation, coding precision, and consistent workflows. Billing accuracy often declines when workflows are not adjusted to match growth.
Delayed payments are frequently linked to billing process gaps, not payer behavior. This is why many providers review billing guidance before choosing a solution.
How do you audit a medical billing company?
How do you audit a medical billing company? In 2026, auditing your medical billing company requires a consistent, data-driven review of performance metrics, processes, and compliance to confirm they are delivering promised value and maintaining a healthy revenue cycle. Start by defining clear KPIs in your contract, such as net collection rate (target 88–95% of allowable), first-pass acceptance (95%+), denial rate (under 5–7%), denial recovery percentage (50–70% of correctable denials), and average AR days (under 35–40). Review these metrics monthly or quarterly through d - MGMA etailed reports the company should provide automatically, comparing them against industry benchmarks and your own pre-outsourcing baseline to spot trends, improvements, or red flags. Request sample claim audits where they supply evidence of submission, follow-up activity, appeals, and resolution for a representative selection of paid, denied, and aged claims. Examine denial logs to verify root causes are being identified and addressed, and appeals are filed timely with proper supporting documentation. Review payer remittance advice and correspondence to ensure payments are posted accurately and underpayments are actively pursued. In my experience, effective audits also include direct conversations with the billing company's account manager about any variances and requests for corrective action plans when performance falls short. Include explicit audit rights in your contract allowing you to access records or commission third-party audits if needed. My strong recommendation is to schedule formal performance reviews at least quarterly, document all findings, and link improvements to contract terms or escalation procedures. Persistent underperformance in collections, AR aging, or denial recovery often signals process gaps, lack of aggressiveness, or resource issues that can cost thousands monthly in lost revenue. In 2026, regular auditing is essential to maintain accountability, protect your revenue, and ensure the partnership continues to deliver measurable results.