Healthcare Institution Billing Audits

Medical billing and reimbursement for the hospital facility come with their own challenges. Dealing with these complications needs experience and expertise in institutional claims processing. Avoid all the complications with our audit experts, who deeply examine every document to ensure error-free claims submission and smooth reimbursements.

Avoid Costly CDM Mistakes

Our auditing team understands the CDM’s components and scrutinizes entries to eliminate errors of unbundled services resulting in compliance issues and potential payer rejections. With significant experience in medical coding standards and guidelines, our team identifies inaccuracies in service descriptions and codes, helping you maximize revenue without compromising patient care quality.

Accurate Service Bundling

MedsIT Nexus is equipped with certified hospital coding experts who perform detailed institutional claims reviews to ensure compliance with payer rules, including those related to service bundling. Our auditing professionals uncover inconsistencies in services bundling, providing healthcare providers with appropriate reimbursement, preventing revenue leakage, and minimizing denials.

Fulfilled Payor Specific Requirements

Healthcare institutions are in the network of various government & private payors, with unique billing and reimbursement rules. Our auditing process thoroughly assesses the institutional claims, ensuring the accuracy and adherence to each payor’s standard, preventing denials and legal issues, allowing healthcare institutions and hospital-based providers to maintain compliance and optimize their financial operations.

Accurate IPD & OPD Claim Classification

MedsIT Nexus medical billing auditors examine the type of billing codes, ensuring they reflect the IPD or OPD setting. Our auditors identify improper payments resulting from incorrect claim classifications. This includes detecting outpatient services inappropriately billed as inpatient services, leading to overpayments or underpayments, and maintaining financial integrity and compliance with payer policies.

Medical Billing for Healthcare professionals - MedsIT Nexus

Healthcare Professional Auditing & Billing

Our expert auditing team reviews the physician's claims and eliminates all the errors before filing them. We cover the category of physician specialties practicing under different business models, including independent private practices and provider-based small physician groups. Our audit services identify discrepancies and address billing inefficiencies to increase profitability and revenue

Accurate Application of Modifiers

Modifiers unlock smooth reimbursements against complex services. Whether it’s a surgical procedure or a detailed consultation, a missing modifier can result in a financial loss. MedsIT Nexus professionals audit team is your reliable billing partner and ensures that every modifier is correctly used to avoid claim denials, underpayments, or overpayments.

Solving Overbilling & Underbilling Challenges

MedsIT Nexus has in-house coding auditors who are well-versed in the professional fee coding standards, ensuring accurate claims submission and preventing upcoding or under-coding errors. We understand federal, state, and payer-specific guidelines, including HIPAA and CMS regulations, that are crucial to avoid non-compliance issues and ensure services are accurately billed, resulting in financial and operational stability.

Streamlining Billing For Unbundled Services

Unbundled services require accurate coding, as incorrect reporting can lead to denials or compliance issues. MedsIT Nexus has a competent audit team that identifies coding errors and ensures proper documentation for unbundled services, resulting in smooth claim acceptance and maximizing revenue.

Simplifying Non-Physician Billing

Reimbursement rules for NPPs differ by payer, state, and service type. MedsIT Nexus auditing professionals evaluate whether billing practices align with these diverse policies, ensuring adherence to payer-specific requirements and timely claims submissions, reducing the risk of denials, and leading to optimized revenue cycle management.

Precise Coding For Off-Label Treatments

Some prescribed treatments are not approved by regulatory bodies, present coding and billing challenges, and demand the justification of medical necessity. MedsIT Nexus has a dedicated team of experienced auditors who fulfill the payor requirements and verify that the coding accurately reflects the necessity of treatment, resulting in lower claim rejections and higher reimbursement.

Regulatory Compliance Assurance

Verifies that prescribed treatments meet regulatory standards and justify medical necessity.

Accurate Coding for Treatments

Ensures coding reflects the necessity of treatments, fulfilling payer requirements.

Reduced Claim Rejections

Proper documentation and justification minimize claim rejections and improve reimbursement outcomes.

Simplifying Outpatient Billing Services

Medical billing and reimbursement vary by outpatient facility settings. Provider-based networks require expertise in institutional billing and coding systems, while freestanding facilities need professional billing and claims processing knowledge. MedsIT Nexus ensures accurate billing and efficient claims management across both systems, optimizing reimbursement and reducing errors.

Expertise in Provider-Based Billing

Ensures accurate institutional billing and coding for provider-based networks, reducing errors.

Private Facility Billing

Specializes in professional billing and claims processing for freestanding settings, optimizing revenue.

Efficient Claims Management

Streamlines billing and claims processes to maximize reimbursement and minimize denials.

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Our Medical Billing Audit Process

MedsIt Nexus understands the value of a comprehensive audit and implements the process to rectify errors in the billing process. We combine our decades of knowledge, expertise and latest technology to run a successful check on the billing process.

Comprehensive Data Gathering Collecting patient records, billing statements, and insurance claims to ensure a thorough audit.
Error Identification Detects discrepancies early to prevent claim denials and billing inaccuracies.
Optimized Reimbursements Ensuring accurate data minimizes revenue loss and enhances claim approval rates.

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Precise Code Validation Ensures CPT, ICD-10, and HCPCS codes align with industry compliance standards.
Error Identification Detects under-coding, over-coding, and missing modifiers that may affect reimbursements.
Improved Workflow Efficiency Reduces claim delays, saves time, and enhances operational productivity.

Boost your practice profit with us

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Error-Free Claim Submission Identifies and eliminates errors that could lead to claim denials or delays.
Revenue Cycle Optimization Enhances reimbursement speed and maximizes financial performance.
Operational Efficiency Boost Streamlines the submission process for smoother and faster claim processing

Streamline your billing operations

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Compliance Assurance Ensures adherence to HIPAA and Medicare guidelines to prevent regulatory violations.
Error Detection Identifies inaccurate documentation and false billing practices that may lead to penalties.
Risk Mitigation Helps healthcare providers avoid compliance risks and financial liabilities.

Protect your practice from penalties

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Revenue Leakage Identification Detects underpaid reimbursements and denied claims to recover lost revenue.
Accounts Receivable Optimization Resolves payment discrepancies and streamlines the collection process.
Accurate Payment Reconciliation Ensures billed amounts match received payments for financial transparency.

Simplify your billing operations

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Detailed Error Reports Provides a clear breakdown of billing inaccuracies and areas needing improvement.
Actionable Insights Offers strategic recommendations to enhance billing accuracy and maximize revenue.
Process Optimization Helps implement best practices for a more efficient and compliant billing system.

Uncover hidden billing revenue

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Initial Verification
Our in-depth audit process begins with data collection and verification. We gather everything including patient records, billing statements, and insurance claims. This initial step helps us to find discrepancies and minimize the chances of claim denials.
Comprehensive Coding Assessment
Our in-house experts closely review the CPT, ICD-10, and HCPCS codes to maintain industry compliance. They double-check the documents to identify under-coding, overcoming, and missing modifiers that can delay reimbursements. This detailed audit helps us find mistakes save valuable time and improve operational productivity.
Claim Submission Analysis
Claim submission is crucial to faster reimbursements and higher profits. Our experts analyze the claim submission process and pinpoint the errors. With accurate identification practices, we offer insights to help you enhance operational efficiency and maximize the revenue cycle.
Compliance Review
MedsIT Nexus team assesses every document and looks for inaccurate documentation, compliance risk, or false billing practices. We ensure that your billing practice follows HIPAA and medicare guidelines. This step ensures healthcare providers follow government regulations and avoid unwanted penalties.
AR and Payment Posting
We cross-check outstanding claims, remaining payments, and denied claims to prevent revenue leakage. Our team optimizes your account receivable process by solving the discrepancies in the payment posting following up on unpaid claims, and ensuring accurate reconciliation between billed and received amounts.
Transparent Reporting
After completing the audit, we generate comprehensive reports indicating errors and necessary actions. Our team provides recommendations to improve billing accuracy and revenue collection. MedsIT Nexus supports healthcare providers in implementing best practices for a streamlined, compliant, and profitable billing process.

Boost Your Revenue with Medical Billing Audit

Medical practices are prone to fraudulent activities, causing massive revenue loss. MedsIT Nexus has in-house medical audit experts to help you avoid unwanted penalties and strengthen revenue streams while focusing on top-quality patient care.

Compliance Assurance

Reduced Errors

Higher Profits

Accurate Documentation

Lower Risks

Enhanced Operational Efficiency

Maximize Revenue and Ensure Accuracy with MedsIt

Regulatory Compliance

Ensures adherence to healthcare laws to avoid legal risks and penalties.

Error Prevention

Identifies documentation gaps to maintain accuracy & transparency

Revenue Protection

Reduces financial losses by correcting compliance issues before they impact reimbursements

Compliance Assurance

A medical audit helps healthcare practices maintain accuracy and transparency. Failure to maintain appropriate documentation leads to legal consequences and costly penalties. MedsIt Nexus is here to help providers deal with such problems and maximize revenue while focusing on patients' treatment.

Avoid penalties and secure revenue

Call us at +1 (516) 665-1869 or get a medical audit expert.

Non-Pediatric care Physicians

93%

New patients

72%

Private insurance

94%

Private patients

80%

Doctors lose up to

$125

Billion in U.S

Because of poor billing practices

Our services are trusted by 2000+ providers

Dr. Ndidi Uka

A-plus Dentistry

"I want to thank MedsIT Nexus for their impeccable service. They are incredibly knowledgeable and work to make sure you receive the maximum reimbursement. Sam, my dedicated Practice Manager, is always available to answer my questions and keep my abreast on the status of my submitted claims. Being able to bill medical services has allowed me to offer the best care."

M. Techeira

Family Medicine

"We are an outpatient family medicine/ primary care practice. Have offices in NYC and Nassau County. MedsIT Nexus handles all our medical billing and insurance claims. We switched from another company and the process was hassle free, no fees and FAST which was important since we operate 6/7 days. They are always available to answer any questions. We definitely recommend!"

Memoona Waheed

Family Medicine & Pain Management

"After reviewing different medical billing companies, I came across MedsIT Nexus. Not only do they offer billing and coding services, but specialize in credentialing and unpaid claims. Their staff is knowledgeable, professional and are easily accessible- inquiries are answered quickly. Thank you MedsIT Nexus for helping us improve our healthcare practice at a competitive rate!"

S. Dhillon

Physical Medicine & Rehabilitation

"I am the manager at a private physical medicine & rehabilitation practice. We operate in 2 different boroughs in NYC through multiple clinics. MedsIT Nexus handles all our medical billing, coding, denials and prior authorizations for all procedures. We are pleased with their same day approvals as well. Their staff is easily accessible, fast & pleasant to work with."

Comprehensive Medical Billing Audit Services

Ensure Reimbursement

10%

30%

90+

98%

Healthcare Institution Billing Audits

Avoid Costly CDM Mistakes

Accurate Service Bundling

Fulfilled Payor Specific Requirements

Accurate IPD & OPD Claim Classification

Healthcare Professional Auditing & Billing

Accurate Application of Modifiers

Solving Overbilling & Underbilling Challenges

Streamlining Billing For Unbundled Services

Simplifying Non-Physician Billing

Precise Coding For Off-Label Treatments

Regulatory Compliance Assurance

Accurate Coding for Treatments

Reduced Claim Rejections

Simplifying Outpatient Billing Services

Expertise in Provider-Based Billing

Private Facility Billing

Efficient Claims Management

00 / 06

Our Medical Billing Audit Process

Boost Your Revenue with Medical Billing Audit

Maximize Revenue and Ensure Accuracy with MedsIt

Regulatory Compliance

Error Prevention

Revenue Protection

Compliance Assurance

Avoid penalties and secure revenue

93%

72%

94%

80%

$125

Experience our secured medical billing services for as low as 2.69% 2000+

Book a free consultant

Get a Free Revenue Cycle Assessment Today

Our services are trusted by 2000+ providers

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Experience our secured
medical billing services
for as low as 2.69%
2000+