Sample report
What a billing audit report looks like
This is the format you'd get back within 48 hours of sending your reports. Oak Street Family Medicine is a made up practice and every number here is invented, so don't read these as results or as what's typical.
Part 1
What you're owed, and how old it is
This practice has $106,370 in open insurance balances, and $26,805 of it is more than 90 days old. We break that down by payer, because a plan with a 90 day filing limit and one with a year need different handling.
Commercial Plan B stands out. It has the largest balance over 120 days and the fastest growing middle buckets, which can mean something changed with that plan and nobody noticed.
Part 2
Why claims get denied
There were 47 denials this month, and four reasons account for all of them. Each one comes with what we'd do about it.
| Reason | Claims | What to do |
|---|---|---|
| Missing information (CO-16) | 19 | Mostly the referring provider. Correct and resubmit, then fix the visit template. |
| Authorization (CO-197) | 13 | Nearly all from one plan. Look for existing authorizations, then give the front desk that plan's list. |
| Eligibility | 9 | Coverage ended before the visit. Check coverage the day before instead of at check in. |
| Duplicate (OA-18) | 6 | Check whether the first claim paid before anyone resubmits again. |
Part 3
What to fix first
The report ends with a ranked list. You can act on it yourself, hand it to your current biller or talk to us.
- 1 Work the 47 denials, closest deadline firstAbout a third are still inside their appeal window, and that window keeps closing.
- 2 Clear the 31 rejections sitting in the clearinghouseThese were never processed, and the filing clock is still running on them.
- 3 Sort the $17,640 over 120 daysCommercial Plan B holds the most. Some will be past their limit, so check those before anyone calls.
- 4 Add referring provider to the visit templateThat one change would stop the most common denial from coming back.
- 5 Send claims soonerClaims go out about 9 days after the visit, which leaves less room to fix problems.
What the report won't do
- Promise a dollar amount. Whether a payer pays depends on the claim and the payer.
- Replace legal or coding advice. If something looks like an overpayment, we'll tell you so you can get advice.
- Tie you to us. It's yours whether you hire us or not.
Get this report for your practice
Send us your denial and A/R reports and you'll have a written report within 48 hours, for free. You can keep your current biller while you decide.