Billing Compliance Audits
Ensure your organization stays ahead of regulatory risks and revenue leakage with our comprehensive Billing Compliance Audit services. We provide a detailed, end-to-end evaluation of your medical coding, billing, and revenue cycle operations to identify inaccuracies, inefficiencies, and compliance vulnerabilities.
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Our audits are designed to protect your practice from costly denials, payer recoupments, and regulatory penalties—while optimizing your revenue integrity.
Our athenaOne Billing Compliance Audit Includes:
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Our Billing Compliance Audit for athenaOne clients is a comprehensive review of your system configuration, workflows, and billing practices to ensure accuracy, compliance, and revenue optimization. We dig into the details of your athenaOne tablespace to identify gaps, reduce risk, and streamline operations—so you can focus on patient care with confidence.
What We Assess
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Encounter Plans & Documentation Templates – Ensure your clinical documentation supports coding and billing requirements, including proper use of structured fields and alignment with medical necessity standards.
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Charge Capture & Coding Configuration – Review charge slips, default codes, and modifiers to catch errors that could lead to undercoding, upcoding, or denials.
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Billing Rules & Claim Logic – Evaluate payer-specific billing rules, claim edits, and automation logic to reduce denials and ensure regulatory compliance.
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Work Queues & Denial Management – Analyze how tasks, denials, and corrections are routed and resolved through your work queues.
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Payer Setup & Credentialing Alignment – Verify that provider enrollment, payer mappings, and plan participation details are accurately maintained in the system.
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Reporting & Compliance Monitoring – Review audit trails, reporting capabilities, and system alerts to support ongoing compliance and proactive oversight.
Why It Matters
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A misconfigured tablespace in athenaOne can lead to revenue leakage, delayed payments, and compliance risk. Our audit provides actionable insights and a clear corrective action plan to ensure your system is fully optimized and audit-ready.
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Let our athenaOne experts help you unlock the full value of your system—accurate coding, faster collections, and peace of mind.
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Whether you need a one-time retrospective review or ongoing proactive audits, our team of certified experts is here to safeguard your revenue and keep your billing processes audit-ready.