Billing and Credentialing Audit Services
Comprehensive billing and credentialing audits to identify errors, ensure compliance, and optimize revenue cycle performance.
PlusMed Solutions offers comprehensive Billing and Credentialing Audit Services to help healthcare providers identify errors, ensure compliance, and optimize revenue cycle performance. Our audits provide actionable insights to prevent claim denials, reduce payment delays, and maintain accurate credentialing records across all payers.
What Is a Billing and Credentialing Audit?
A billing and credentialing audit is a systematic review of a healthcare provider's billing practices and credentialing documentation to ensure accurate coding and claim submission, compliance with payer rules and regulations, timely and correct provider enrollment and credentialing, and reduction of denied or rejected claims. Audits help identify gaps in processes, reduce revenue leakage, and mitigate regulatory risk.
Comprehensive Billing Audit Services
Claim Accuracy Review
Our team reviews submitted claims to ensure correct CPT, HCPCS, and ICD-10 coding, appropriate use of modifiers, accurate patient and insurance details, and proper documentation to support medical necessity.
Denial Analysis
We analyze claim denials and rejections to identify root causes and recurring issues, categorize denials by payer, procedure, or specialty, and recommend process improvements to prevent future denials.
Revenue Recovery
Through careful review of historical claims, our audits uncover underpaid claims, missed billing opportunities, unbilled services, and delayed or unprocessed claims.
Comprehensive Credentialing Audit Services
Provider Credential Verification
We audit credentialing records to ensure active and valid medical licenses, board certifications and continuing education compliance, DEA registration and state-specific requirements, and malpractice insurance coverage.
Credentialing Compliance Check
Our team verifies that all provider documentation meets payer requirements for Medicare, Medicaid, and commercial insurance, CAQH profiles and attestations, and enrollment and re-credentialing timelines.
Credentialing Gaps Identification
We identify missing, expired, or inaccurate documentation that could lead to claim denials, payment delays, and non-compliance with payer contracts.
Key Benefits
Specialties We Support
- Primary Care and Internal Medicine
- Cardiology
- Orthopedics
- Radiology & Imaging
- Mental Health and Behavioral Health
- Urgent Care
- Physical Therapy and Rehabilitation
- Specialty and Surgical Practices
Why Choose PlusMed Solutions
- Experienced audit specialists in billing and credentialing
- Expertise with Medicare, Medicaid, and commercial payers
- HIPAA-compliant and secure processes
- Scalable solutions for practices of all sizes
- Detailed reporting and actionable recommendations
Get Started Today
With PlusMed Solutions' Billing and Credentialing Audit Services, healthcare providers can prevent revenue leakage, improve operational efficiency, and maintain compliance—while focusing on delivering quality patient care.
Contact Us NowExplore Other Services
Provider Credentialing & Enrollment Services
Complete medical credentialing, re-credentialing, and provider enrollment services for healthcare providers across the United States.
Advance Insurance Eligibility Verification Services
Comprehensive advance insurance eligibility verification to confirm patient coverage before services are rendered.
Prior Authorization Services
Comprehensive prior authorization and pre-certification services to obtain timely approvals from insurance payers.