Yes. A medical billing company can often perform a preliminary revenue-cycle audit before a practice commits to a long-term outsourcing agreement. A limited assessment can review AR, claim activity, denials, coding, charge capture, and payment patterns so practice owners can understand current revenue-cycle problems and evaluate the billing partner’s approach before making a larger commitment.
The Medicator’s revenue cycle management services can be evaluated around the specific operational issues identified during an assessment rather than assuming every practice needs the same billing solution.
What can a pre-contract audit actually reveal?
A useful review should go beyond saying that AR is “high.” Depending on the agreed scope, the auditor can examine:
- AR aging: Which payers and accounts are creating the backlog?
- Claim Denials: Are recurring problems related to eligibility, authorization, coding, documentation, or payer processing?
- Charge capture: Are completed encounters reaching the billing workflow?
- Medical Coding: Are CPT and ICD-10 processes creating avoidable claim problems?
- Payment Posting: Are insurance payments, adjustments, and patient balances being posted correctly?
- Payer performance: Are certain payers producing unusual delays or underpayments?
- Front-end processes: Are Eligibility Verification and Prior Authorization workflows contributing to downstream problems?
What should the practice provide?
The scope may include selected AR aging reports, claim data, remittance information, denial reports, charge data, payer information, and relevant workflow documentation.
Do not provide unrestricted access simply because an audit is being called “preliminary.” Define what data is being reviewed, why it is needed, who can access it, how it will be protected, and what happens to it afterward.
When protected health information is involved, the appropriate contractual and privacy safeguards should be established before access is provided, including a Business Associate Agreement where applicable.
A smart way to use the audit
Ask the billing company to separate findings into three categories:
Immediate revenue risks: Accounts or claims requiring prompt action.
Process weaknesses: Problems such as recurring eligibility or authorization failures.
Longer-term opportunities: Areas where workflow changes could improve RCM performance.
For example, a gastroenterology practice might discover that older denied claims are not the primary problem. The audit could instead reveal that incomplete Prior Authorization documentation is repeatedly creating avoidable downstream work.
What should you ask before agreeing?
Request a written scope covering:
- Reports and data required
- Sample size or review period
- Areas being audited
- Deliverables you will receive
- Data-security responsibilities
- Fees, if any
- Whether the assessment creates any long-term obligation
The Medicator’s medical billing audit services can provide a more focused review when a practice wants to investigate billing accuracy, workflow gaps, or revenue leakage before changing its broader RCM arrangement.
A pre-contract audit is most useful when it produces actionable findings rather than a sales presentation. Ask the prospective billing partner to show the evidence behind each recommendation and explain which problems it would address, how, and in what order.
