What the audit examines
The audit covers the full cycle, because leakage is rarely confined to one stage. A clean coding department cannot save a practice that writes off timely-filing denials.
- Coding accuracy: undercoding, overcoding, modifier misuse, E/M level distribution
- Charge capture: missed charges, unbilled encounters, unposted procedures
- Claim scrubbing effectiveness and first-pass acceptance rate
- Denial patterns by payer, reason code, provider and service line
- A/R aging distribution and write-off practices
- Payer contract compliance and underpayment detection
- Patient responsibility collection rate and statement cycle
- Credentialing status gaps that invalidate claims
- Compliance risk: documentation support, medical necessity, audit exposure

