Audits That Start With
Your Data—Not a Checklist
We analyze your billing trends first to pinpoint where risk and revenue loss actually live—then send our certified auditors exactly where it matters most.
If your practice is experiencing any of these, a forensic-led audit is the smartest first move:
Forensic Data Audits:
Smarter Targeting, More Meaningful Results
Random chart pulls tell you what went wrong in a sample. Forensic data analysis tells you where your biggest risks and revenue gaps are hiding—before we ever open a single chart.
We start every engagement by running a forensic review of your billing data against current national and payer-specific trends. We look at your code utilization, denial patterns, modifier frequency, payer mix, and procedure distribution—then compare it to benchmarks for your specialty and region.
What comes back isn't a guess. It's a precise map of exactly which providers, codes, or service lines warrant a deeper look. That's where we direct the chart audit. The result: fewer wasted reviews, clearer findings, and corrective action that actually moves the needle.
- Random or subjective chart selection
- Findings may not reflect actual risk
- Equal effort on low- and high-risk areas
- Reactive—fixes last quarter's problems
- Data identifies where to look first
- Chart review targets confirmed anomalies
- Effort focused on your highest-risk areas
- Proactive—aligned to current billing trends
We pull your claims data, code utilization history, denial reports, and payer mix.
We benchmark your patterns against specialty norms and current CMS / payer trends.
We identify exactly which providers, codes, or service lines are outliers—and why.
Certified auditors review only the charts the data flagged—maximizing accuracy and impact.
You receive findings backed by both data and clinical review—with a prioritized corrective action plan.
All Audit Services
Our forensic-led approach is how we prefer to start—but we offer every type of audit your practice needs, each tailored to your specialty, payer mix, and compliance priorities.
Forensic Data Audit + Targeted Chart Review
Our signature service. We analyze your billing data against current trends first, identify your real risk areas, then send certified auditors exactly where it counts—delivering findings that are specific, defensible, and directly tied to what's happening in your practice right now.
- Billing trend analysis vs. specialty & national benchmarks
- Data-identified risk areas drive chart selection
- Findings are meaningful—not based on random sampling
- Proactive alignment to current CMS and payer priorities
Prospective Chart Audits
Pre-submission review of charts and codes to catch errors before claims go out the door—protecting revenue and compliance in real time.
- Reduce denial rates before they happen
- Ensure documentation supports billed codes
- Strengthen coder accuracy over time
Retrospective Chart Audits
Post-submission review to identify overpayments, underpayments, and compliance exposure—with actionable remediation guidance.
- Identify revenue recovery opportunities
- Detect and correct past billing errors
- Support compliance corrective action plans
E/M Audits
Expert-level evaluation and management coding reviews under 2023 AMA guidelines—the most scrutinized area in outpatient billing.
- MDM and time-based documentation review
- Level-of-service accuracy assessment
- Physician-specific feedback reports
Compliance-Focused Audits
Systematic reviews aligned to OIG Work Plan priorities, payer policies, and CMS guidelines—so you're never caught off-guard.
- OIG & payer risk area review
- Modifier usage and medical necessity
- Compliance gap identification
Billing Audits
Deep review of your billing workflow, claim submission, and payment posting to surface errors and inefficiencies impacting your bottom line.
- Charge capture accuracy
- Denial root-cause analysis
- Payer contract alignment review
ASC & Facility Audits
Specialized auditing for ambulatory surgery centers covering facility billing, implant reporting, and bundling rules unique to ASC reimbursement.
- Facility fee and physician fee separation
- Bundling and add-on code review
- Supply and device reporting accuracy
How a Forensic-Led Audit Works
We follow a data-first methodology that ensures every chart we review is one that actually matters—saving time, reducing noise, and delivering findings you can act on with confidence.
Submit Your Request
Tell us about your practice, specialty, and goals. We'll confirm scope and timeline within one business day and send over a simple data request.
Forensic Data Analysis
We analyze your billing data—code utilization, denial rates, modifier patterns, and procedure distribution—benchmarked against current specialty and payer trends to pinpoint where risk actually lives.
Targeted Chart Review
Our certified auditors review only the charts the data flagged—conducting a thorough, HIPAA-compliant review using current CMS rules, AMA guidelines, and payer policies.
Report & Action Plan
You receive a data-backed, provider-friendly report with specific findings, error rates, and a prioritized corrective action plan grounded in what your billing data actually shows.
We Know Your Specialty—Not Just the Codes
Our auditors don't just know the rules—they know the nuances. From high-volume primary care to complex surgical specialties, we bring real-world coding experience that generic audit tools can't replicate.
Don't see your specialty? We likely cover it—just ask in your request.
The Difference a Focused Audit Partner Makes
Clinically Credentialed Auditors
Every audit is conducted by certified professionals (CPC, CPMA, CPCO, CCS, or equivalent) with hands-on specialty coding experience—not generalists.
Tailored, Not Template-Driven
We customize each review to your payer mix, specialty, and risk areas—so your report reflects your practice, not a one-size-fits-all checklist.
Actionable, Plain-English Reports
Findings are presented clearly, with specific examples and prioritized next steps your billing team can implement immediately—no decoder ring required.
Education Built In
We don't just identify errors—we explain why they happened and provide targeted education to prevent recurrence and build your team's expertise.
Collaborative Approach
We work alongside your team—not as critics—supporting continuous improvement and partnering with you through corrective action when needed.
HIPAA-Compliant & Secure
All chart reviews follow strict HIPAA protocols. We execute a Business Associate Agreement (BAA) before touching any patient data.
Request Your Audit
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Request Received!
Thank you—we've received your audit request and will be in touch within one business day to schedule your kickoff call.
In the meantime, reach us directly at info@healthcareinspiredllc.com.
Back to HomeNot sure what type of audit you need?
We'll help you figure it out. Reach out directly and we'll point you in the right direction—no commitment required.