Revenue Integrity Master Audit

100 Checkpoints. 7 Phases. Full Lifecycle.

1

Patient Access — Intake & Registration

Insurance card scanned and data entered accurately

Wrong payer ID, transposed member number, or misspelled subscriber name leads to claim rejection at submission; delays revenue 30+ days.

Critical
Patient demographics verified and accurate

A misspelled name, transposed DOB, or wrong address causes CARC 16 denial; payer cannot match to subscriber. "Collected but wrong" equals same outcome as "never collected."

Critical
Prior authorization obtained where required

Services rendered without authorization are denied retroactively; non-recoverable write-off.

Critical
Financial responsibility discussed and documented

Aging A/R increases; patient disputes at collections stage.

High
Rendering provider and facility information confirmed

Claim billed under wrong NPI/TIN or place of service → CARC 185 denial.

Critical
Subscriber relationship code verified

Payer cannot match claim to policy; subscriber name misspelled means the relationship link breaks.

High
Coordination of benefits confirmed

Claim sent to wrong payer; OA-23 denial (COB issue); double billing compliance risk.

High
ABN / financial consent forms obtained

Cannot bill patient for non-covered services; compliance liability.

High
Accident / injury information collected

Claim sent to health insurance instead of liability carrier; recoupment later.

Medium
Legal name verified against insurance card

Patients misspell their own names or give nicknames. "Kathy" vs "Katherine" — the payer doesn't know your patient's nickname.

High
Data entry accuracy validated

One wrong character cascades through eligibility, claims, and payment. A single transposed digit denies every claim for that patient.

Critical
Insurance card image stored in system

When a claim denies for subscriber mismatch, staff has no source document to compare against; must call patient or payer to re-verify.

Medium
Demographics re-verified at each visit

Insurance changes, name changes, address changes happen between visits. Stale data from 6 months ago causes today's claim to deny.

High
2

Eligibility & Authorization — The Front-End Guard

Real-time eligibility verification run before service

Services rendered to terminated or inactive policies; total revenue loss on that encounter.

Critical
271 response codes interpreted correctly

Staff doesn't understand rejections; patient seen anyway without coverage confirmation.

High
Benefit type and coverage verified

Visit billed to wrong benefit type; payer denies as out-of-network or not covered.

High
Patient copay/coinsurance/deductible collected

Point-of-service collections drop; increases patient A/R and cost to collect.

High
Prior authorization obtained and documented

Claim denied for no auth on file; retrospective auth often denied; total write-off.

Critical
Authorization number linked to claim

Auth exists but isn't on the claim; denied anyway — avoidable rework.

High
Authorization expiration tracked

Services rendered after auth expires; payer denies all post-expiration claims.

Critical
3

Clinical Documentation & Coding — The Revenue Foundation

E/M level matches documentation

Downcoded by payer audit; recoupment; compliance risk for upcoding.

Critical
All services documented and charged

Charge capture gap — services rendered but never billed; silent revenue loss.

Critical
ICD-10 codes at highest specificity

Unspecified codes trigger edits or denials; LCD/NCD non-compliance.

High
Charges entered within 24–48 hours of service

Claim submission delayed; approaches timely filing limits; incomplete charge capture.

High
Modifier usage correct (CCI edits reviewed)

CCI edit denials; OIG audit exposure; modifier -25, -59 errors are top denial reasons.

Critical
Diagnosis supports medical necessity

Medical necessity denial; payer sees no clinical justification for procedure.

Critical
Place of service code accurate

Reimbursement at wrong rate; facility vs. non-facility payment differential can be 40%+.

High
Charge capture reconciliation performed

Revenue leakage; average practice loses 5–10% of revenue to missed charges.

High
4

Provider Management — Credentialing & Enrollment

All providers credentialed with all contracted payers

Payer enrollment blocked; cannot bill until credentialing complete; pre-revenue gap.

Critical
Re-credentialing calendar maintained

Payer pulls enrollment; re-credentialing delays.

High
NPI/TIN match payer records exactly

NPI mismatch between claim and payer file = automatic rejection.

Critical
New provider enrollment initiated within 30 days of hire

CARC 185 denials; days 0 to enrollment = zero revenue for that provider/payer combo.

Critical
Fee schedules loaded and current

Under-billing or overpayment recoupments; cannot identify underpayments on remittance.

High
Pre-revenue gap tracked per provider

No visibility into pre-revenue gap; provider sees patients but practice eats the cost.

High
Taxonomy codes match payer requirements

Claim rejected at clearinghouse level; silent rejection — never reaches payer.

High
5

Claims Submission — 837 Generation & Scrubbing

Claims scrubbed before submission

Preventable denials; industry avg 5–10% initial denial rate, most are scrub-catchable.

Critical
Duplicate claim logic in place

CARC OA-18 denials; payer flags practice for duplicate billing patterns.

High
Timely filing deadlines tracked

Claim filed past deadline; CO-29 denial; 100% write-off with no appeal rights.

Critical
Claims submitted electronically (837P/I)

Manual entry errors; unstructured data cannot be validated programmatically.

High
Clearinghouse edits reviewed and resolved

Front-end rejection before claim ever reaches adjudication; no denial generated — claim vanishes silently.

Critical
Rendering provider NPI correct on claim

Payer attributes service to wrong provider; CARC 185 if rendering provider not enrolled.

Critical
Subscriber/member ID verified against card

One wrong digit and payer cannot locate the policy; CARC 27 denial.

Critical
Patient DOB and name match payer records

CARC 16 — #1 preventable denial. A DOB entered incorrectly denies every time.

Critical
Correct payer ID on claim

Claim routed to wrong processing queue; returned as "payer not found."

High
Coverage dates verified

Denial for service outside coverage period; often non-recoverable.

High
Group number included where required

Some payers reject without group number; others route to wrong benefit plan.

Medium
Billing provider NPI/TIN match W-9

Payment held or sent to wrong address; 1099 mismatch; IRS compliance issue.

High
Claim frequency code correct

Corrected claim treated as duplicate; voided claim not processed.

High
Bundling rules applied correctly

Lower-paying code denied as inclusive of higher-paying code; or both denied for improper unbundling.

Critical
Units billed match services rendered

Entire line denied or paid at reduced units; appeal required.

High
Medical necessity diagnosis linked to procedure

Denial for "not medically necessary" (CARC 50); requires clinical appeal.

Critical
Modifier -25 used correctly

E/M denied when billed same day as procedure; or audit triggers for modifier -25 overuse.

High
Modifier -59 used correctly

Bundled code denied; if overused, triggers OIG audit for modifier -59 abuse.

Critical
Global surgery rules applied

Post-op visit denied as included in surgical global period; 10/90-day window revenue loss.

High
EDI format validated before submission

Automatic rejection at clearinghouse; flags practice for data quality issues.

High
NDC codes included for drug claims

Drug claims denied for missing NDC; Medicaid plans especially strict.

High
Revenue code / CPT match verified (facility claims)

Revenue code / CPT mismatch denial; common on outpatient facility claims.

High
Primary diagnosis supports procedure

Payer adjudicates based on primary DX; may deny if it doesn't justify the service.

Critical
Diagnosis pointers linked correctly

Line rejected for "missing diagnosis" or paid incorrectly because wrong DX was linked.

High
Specificity of diagnosis codes verified

Payer returns for more specific code; some payers auto-deny unspecified codes entirely.

High
Place of service code matches service location

Facility vs. non-facility rate differential can be 40–60%; wrong POS = wrong reimbursement.

High
Telehealth modifiers applied correctly

Telehealth visit denied or paid as in-person at wrong rate; rules vary by payer and state.

High
Ordering provider NPI included for diagnostics

Denial for missing ordering provider; Medicare requires ordering NPI on all diagnostic tests.

High
Supervising provider NPI on incident-to claims

Incident-to claim denied; some payers require supervising physician NPI for NP/PA services.

High
Service facility address correct

Payer uses billing address as service location; may deny for out-of-network pricing.

Medium
ABN on file for Medicare non-covered services

Cannot bill Medicare patient for denied services without ABN; compliance violation.

Critical
MIPS/QPP reporting requirements met

Negative payment adjustment up to -9% on all Medicare claims for the performance year.

High
State-specific Medicaid rules applied

State Medicaid rules differ dramatically; what works in one state causes denials in another.

High
Carved-out benefits identified and routed correctly

Service denied as "not a covered benefit"; bill sent to wrong entity.

High
Workers' comp / auto claims handled separately

Claim rejected; WC and auto require different data elements than standard claims.

High
Modifier validation rules applied

Claim denied for "invalid modifier" even though the service was performed correctly.

High
High-dollar claims reviewed before submission

High-value claim denied for preventable error; cost of rework is amplified.

High
New patient claims reviewed for accuracy

First impression with payer sets the tone; incorrect data creates recurring denial pattern.

Medium
Unbilled claims monitored daily

Claims aging in unbilled status; timely filing clock running; revenue delayed.

Critical
Claims submitted within 48 hours of service

Slow submission compresses follow-up window; claim ages before adjudication.

High
Authorization number on 837 claim

Auth exists in your system but never makes it onto the 837; payer denies for "no auth on file."

Critical
Supporting documentation attached when required

Claim pends for additional information; payer sends Development Letter delaying payment 30–60 days.

High
Corrected/voided claims use proper frequency codes

Payer treats corrected claim as duplicate or new claim; original remains unpaid.

High
Batch-level claim audits performed

Systemic errors go undetected; same mistake repeated across hundreds of claims.

High
Rejected claims tracked and resolved same day

Rejected claims sit in limbo; timely filing clock is still running.

Critical
Secondary/tertiary claims submitted timely

Secondary revenue never collected; average 8–15% of total revenue in multi-payer scenarios.

High
Batch file delivery confirmed

Claims silently dropped from batch; no denial generated — just missing revenue.

Critical
6

Payment & Remittance — 835 Processing & Reconciliation

835 remittances auto-posted or reviewed

Manual posting errors; adjustments applied to wrong claims; A/R integrity compromised.

Critical
Contracted rates verified against payments

Payer quietly pays below contracted rate; practice absorbs the shortfall unknowingly.

Critical
Patient balances billed promptly

Patient never billed for their portion; coinsurance/deductible revenue lost.

High
Unallocated payments investigated

Posting imbalance; unidentified money in system; audit trail broken.

High
Bank deposits reconciled to remittances

Unmatched deposits; cannot prove which claims were paid in which deposit.

High
Recoupments reviewed before write-off

Payer claws back money and it's written off without review; often recoupments are disputable.

High
Denials flagged for follow-up (not auto-written off)

Recoverable denials treated as write-offs; money left on the table.

Critical
7

Denial Management & A/R — Recovery & Collections

Denials routed to appropriate team

Billing team works denials they can't resolve; credentialing issues sit unworked.

Critical
Patient responsibility separated from payer denials

Staff wastes time appealing patient responsibility or contractual write-offs.

High
Appeal deadlines tracked and enforced

Appeal rights expire; recoverable claim becomes permanent write-off.

Critical
Denial root cause analysis performed monthly

Same denials repeat month over month; systemic issues never addressed.

Critical
A/R aging reviewed weekly by bucket

Claims age past timely filing; probability of collection drops 50% after 90 days.

Critical
Patient statements sent within 30 days of adjudication

Patient collection rates drop significantly after 60 days; increases bad debt.

High
Write-off approvals documented and auditable

Revenue silently disappears; embezzlement risk; no accountability on adjustments.

High
Compliance auditing performed

False Claims Act exposure; payer audit findings; state regulatory penalties.

Critical

Your Revenue Integrity Scorecard

A summary of your audit findings across all 7 phases of the patient-to-payment lifecycle.

0 / 100 checked

Check items above to see your score.

Every unchecked box is revenue at risk.

Next Steps

Build Your 90-Day Roadmap

Your audit results identify where revenue is leaving. Use the Custom 90-Day Action Plan to turn those gaps into a structured remediation roadmap with self-help steps, expert escalation options, and automation recommendations.

Build My 90-Day Roadmap → Search EDI Database Get Appeal Templates Book a Consult