- (773)-985-1869
- info@stream-rcm.com
- 14430 Ocean Point, El Paso, TX 79938
Stream RCM is a medical billing auditing company which identifies coding errors, compliance gaps, and revenue leakage. We help medical practices, hospitals and clinics with billing accuracy, reduce denials, and ensure compliant documentation through expert-led best medical billing audit services.
A medical billing audit is an organized evaluation of the billing process, coding, and reimbursements with the aim of reviewing the entire process and catching anomalies or possible risk of non-compliance with regulations or loss of revenue. Medical billing auditing services assist a medical practice in spotting these irregularities before a payer or recovery evaluation takes place.
Healthcare organizations benefit by having an understanding of their billing performance, denials, and compliance risks, which in effect allows for cash flow, fewer payor problems, and continuous operational productivity through the partnership with a medical billing audit company. A RCM audit company provides integrity to the revenue cycle, also safeguarding the practice from costly penalties, both internal or external.
Ensures that CPT, ICD-10, and HCPCS codes match documentation and payer requirements.
Identifies regulatory risks, payer policy gaps, and audit exposure within billing operations.
It identifies discrepancies in underpayment amounts and missed charges and inconsistencies.
Validated clinical records completely support billed services and established medical necessity.
Medical billing audits help practices stay compliant, minimize payer challenges, and optimize revenue in today’s evolving healthcare and value-based care environment.
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Comprehensive medical billing and coding audit services personalized for hospitals, medical practices, and RCM teams.
A complete medical billing accuracy audit to assess coding accuracy, documentation support, modifier usage, and payer guideline compliance across submitted claims to identify errors, revenue leakage, and audit exposure.
Comprehensive CPT, ICD-10 and modifier testing and validation to guarantee regulatory compliance, payer policy compliance, less recoupment risk and better coding consistency across specialties and provider documentation standards.
Hospital bill audit services of inpatient claims, outpatient claims, and facility-based claims to verify the accuracy of coding and documentation, the correctness of reimbursement and adherence to payer and CMS regulations.
End-to-end revenue cycle measurement, gap in the workflow, denial patterns, under payments, and inefficiencies in the process with the aim of enhancing reimbursement performance, stability of compliance, and financial transparency.
Proactive auditing of medical bills detecting weaknesses, compliance issues, and risk of documentation prior to external audit by a payer, CMS audit, or regulatory audit and minimizing financial exposure and operational interruption.
Corrective action planning describes the process of implementing an action plan aimed at addressing audit results to overcome ineffective performance to ensure that the performance is enhanced and sustained over time.
Real-world outcomes delivered by one of the best medical billing audit companies.
17% of claims were denied
due to Modifier 25 stacking errors
Recovered $112K within three days with a 94% appeal success rate
Chronic undercoding reduced reimbursements
due to across management services.
Inpatient coding inconsistencies triggered
due to payer audit exposure.
High denial rates tied to documentation insufficiencies.
Denials reduced by 38% following targeted audit and education.
Targeted medical billing audit services addressing root-cause issues with measurable outcomes.
The misuse of CPT, ICD-10, and modifiers leads to denials, underpayments, audits, which are commonly encouraged by outdated guidelines, documentation inconsistencies, and inadequate supervision, resulting in lost revenues subjected to audits by payers.
Billing audits reports that validate coding to payer regulations and documentation provide corrective guidance, specific education, and process enhancements to improve accuracy, compliance, decrease denials, and balance reimbursement practices across services.
Unfinished or irregular clinical records are not sufficient to support billed care, and more denials and higher recoupment risk and audit results in addition to undermining the support of medical necessity, payer trust, and reimbursement competence overall in encounters.
To ensure that medical records are entirely in support of the claims made, reduce denials, enhance compliance, and enhance reimbursement defensiveness during the payer reviews process, our medical billing audit checklist evaluates medical necessity, completeness of documentation, and consistency to assure the complete support of claims in medical records.
Chronic denials of claims drain resources, slows the cash flow, and hides underlying problems, such as coding errors, documentation breaches, workflow inefficiencies, which do not allow solving the situation sustainably and predictable performance reimbursing overtime.
We examine patterns of denials, root cause and payer behaviors and introduce corrective RCM audit solutions that result in minimized recurrence of denials, workflow optimization, faster cash flow and enhanced long-term reimbursement stability results.
Undisclosed compliance gaps reveal practices to payer audit and penalty, recoupments that are usually a result of regulatory modification, varied processes, and missing internal surveillance in billing, coding, and documentation activities operations in general.
Our medical billing audit firm conducts compliance-driven audit undertaking in line with the existing regulations, early risk identification, enhanced internal controls, advocacy of the corrective action, and audit readiness in dynamic payer needs throughout the country.
Missed charges, undercoding and omissions in billing slowly add up to diminish profitability, constraining cash flow and misrepresenting a financial performance but covering up actual service worth offered to patients in patient encounters over time and operations.
We identify missed revenue due to ineffective audit reviews of medical bills, identification of under payments, missing charges, and process gaps and recommend corrections to recover lost revenue, increase margins, and sustain financial growth.
Reduce risk, recover revenue, and gain audit confidence with expert medical billing audits.
We are able to merge a strong knowledge of the depth of regulation, practical experience of billing, as well as data-driven approaches, and provide accurate and actionable outcomes being a reputable medical billing auditing company. Our audits are transparent, personalized and aimed at long term improvement and not generic findings. In independent practices in the multi-hospital sector, our medical billing audit services assist organizations to reduce denials, maximize reimbursements, strengthen compliance, and secure long-term revenue. Under our professional guidance, healthcare providers are assured of confidence, efficiency, and accuracy in all billing processes and RCM processes.
Our audit process follows a focused, compliance-driven framework designed for accuracy, efficiency, and measurable outcomes. Each step addresses critical billing risks while supporting sustainable revenue improvement and regulatory readiness.
Medical billing audit refers to the systematic examination of the claims, coding, documentation, and reimbursement plans in order to determine their accuracy, conformity, and financial soundness. It assists in determining payment mistakes, overpayments, underpayments, and regulatory risks and enhances billing patterns and guards’ healthcare entities against billing audits and fines.
There are four standard types of audits including internal audits, external audits, prospective audits and retrospective audits. Internal audits are self-conducted, external audits are led by the payer, prospective audits are conducted in advance of claim submission and retrospective audits are conducted on claims after payment in order to determine accuracy and compliance.
Medical billing follows the golden rule, which imparts payment only in case of services that are well documented, medically required and properly coded. All billed services will have to be well documented and comply with payer requirements to minimize the number of denials and endure audits or reimbursement reviews.
There are 5 C’s of audit which are Criteria, Condition, Cause, Consequence and Corrective action. They establish the definition of what ought to have happened, what actually happened, the cause of the issue, its effect, and the action to be taken in order to resolve problems and prevent eventual findings of audit in the future.
Medical audit has seven principles, which are relevance, validity, reliability, objectivity, confidentiality, transparency, and continuous improvement. Such principles ensure fairness, accuracy, evidence-based audits, adherence to regulations, and consideration of the quality, compliance, and financial results.
Some of the common audit red flags entail high denial rates, high use of the modifiers, inconsistent documentation, upcoding or undercoding trends, frequent corrections on claims, abnormal billing volumes, and non-adherence to payer policies. Such signs will tend to cause further inspection, refunds, or rectification needs
Improve compliance, reduce denials, and safeguard revenue through expert-led medical billing audit services.
