Medical Billing Audit Services That Find Problems Before OIG, RAC, or a Payer Does
Under the Affordable Care Act's 60-day rule, a practice that identifies an overpayment has 60 days to investigate, quantify, and refund it, or the exposure shifts from a billing correction to a False Claims Act liability. The math behind waiting is not abstract: a problem caught in a routine quarterly audit might mean refunding $8,000 and moving on, while the same error left unchecked for three years can mean a $80,000 refund demand that threatens the practice itself. Federal enforcement is not slowing down either. Fiscal year 2025 alone saw a record $6.8 billion in False Claims Act recoveries, with Medicare Advantage-related cases driving a substantial share of that total. CureBytes conducts structured coding, charge capture, and compliance audits built to hold up under OIG and payer scrutiny, so your practice finds its own mistakes first, while they are still small and still yours to control.
BUILT FOR PRACTICES
Built for Practices That Would Rather Find Their Own Mistakes First
An audit that reviews 10 or 15 claims and draws a sweeping conclusion is not a defensible audit, it is a guess with a report attached. Industry guidance calls for a minimum of 30 claims per provider before a finding is considered statistically meaningful, and where multiple auditors are involved, a properly run program tests inter-rater agreement to confirm the findings would hold up consistently, not just under one reviewer's judgment. That level of rigor matters because a coding or compliance audit is not only about catching overbilling. Practices routinely undercode and underbill as often as they overbill, and a properly scoped audit surfaces both, correcting the compliance risk on one side while recovering revenue that was simply never claimed on the other
Coding accuracy audits against current CPT, ICD-10-CM, and HCPCS Level II code sets
Charge capture audits to catch under-billed or missed service
Compliance risk audits scoped around current OIG Work Plan priorities
Statistically valid sampling with documented, defensible methodology
Overpayment quantification and self-disclosure support alongside legal counsel
Corrective action planning and a re-audit to confirm the fix actually held
A quarterly audit that costs you an $8,000 refund is a manageable Tuesday. The same problem left to compound for three years is the kind of number that changes what a practice can afford to survive
Bech Mark
Audit Standards You Can Check Against the Benchmark
95% +
30+ Claims
60 Days
Coding Accuracy, the CMS -Aligned Industry Standard
Minimum Statistically Valid Sample Per Provider
Window to Report and Refund an Identified Overpayment
Quarterly
90% +
60-90 Days
Recommended Frequency for High-Risk Service Lines
Inter-Rater Agreement Target on Multi-Auditor Findings
Re-Audit Window After Corrective Action
CODING AUDITS
Coding Audits Built to Withstand OIG and Payer Scrutiny
A coding audit that would not survive an external review is not really protecting your practice, it is just paperwork. Our AAPC and AHIMA-credentialed auditors review documentation against all six core checkpoints, patient demographics, CPT and ICD-10-CM accuracy, medical necessity, CMS and OIG alignment, modifier usage, and E/M leveling, using a statistically valid sample and a documented methodology that would hold up if a payer or the OIG ever asked how the findings were reached.
Documented audit methodology with credentialed auditor sign-off
Minimum 30-claim statistically valid sampling per provider
Findings scoped to current OIG Work Plan risk priorities
CAPTURE AUDITS
Charge Capture Audits That Catch Missed Revenue, Not Just Errors
Overbilling is not the only risk sitting inside your claims history. Undercoding and missed charge capture quietly cost practices real revenue every month, and because underbilled claims rarely trigger a denial or an audit flag, they can go unnoticed indefinitely. We review documentation against what was actually billed to identify services performed but never captured, so an audit protects your compliance standing and your revenue at the same time.
Documentation-to-charge comparison to catch missed billable services
Undercoding identification alongside standard overbilling review
Quantified revenue recovery opportunity included in every findings report
OVER PAYMENT QUANTIFICATION & SELF DISCLOSURE
Overpayment Quantification and Self-Disclosure Support
Once an audit identifies a credible overpayment, the 60-day rule starts a clock that does not pause for internal deliberation. We quantify the overpayment, document the calculation methodology, and support your legal counsel through the self-disclosure decision, since providers who voluntarily disclose through OIG’s Self-Disclosure Protocol have historically seen substantially reduced penalties compared to those caught through an external audit, along with a suspended repayment deadline while the matter is under review.
Overpayment calculation with documented methodology and supporting analysis
Coordination with legal counsel on self-disclosure decisions
Refund and corrective action documentation to demonstrate 60-day rule compliance
MEDICAL BILLING AUDIT
How Our Medical Billing Audit Process Works
Every audit engagement, whether it is a routine quarterly review or a response to a suspected compliance issue, follows the same disciplined process.
Scope and Sample Selection
We define the audit scope around your highest-risk service lines and current OIG Work Plan priorities, then pull a statistically valid, minimum 30-claim sample per provider
Documentation and Coding Review
Findings Report With Quantified Impact
We Audit Against the Standards That Actually
Get Enforced
A generic checklist audit does not protect a practice the way a review scoped to the standards
An actual investigator would use it. Our audit methodology is built around
the frameworks that govern how OIG, CMS, and
Payers evaluate billing compliance.
An Honest Comparison of a Proactive Internal Audit vs.
Waiting for an External One
A transparent, side-by-side look at what it costs to find a problem yourself versus
letting a payer or the OIG find it first.
Medical Billing Audits Built for the Way Your Practice
Actually Needs Them
Practices That Have Never Conducted a Formal Coding Audit
Medical billing audits are priced as a flat fee per engagement, based on provider count and sample size, confirmed before the audit begins. Every audit includes a documented findings report and a specific corrective action plan, not just a list of errors with no path forward. We do not make self-disclosure decisions on your behalf, since that is a legal determination, but we provide the quantified findings your legal counsel needs to make that call quickly and with confidence
Practices Preparing for a Payer or RAC Audit
We run an internal review scoped to the same risk areas an external auditor is likely to target, so nothing in that review is a surprise.
Practices With Suspected Overpayment or Compliance Risk
We quantify the actual exposure quickly, since the 60-day rule clock starts running the moment a credible overpayment is identified
Practices Wanting Ongoing Quarterly Audit Coverage
We build a recurring audit schedule around your highest-risk service lines, so compliance monitoring is continuous instead of a once-a-year scramble
Pricing
Transparent Pricing. No Contracts. No Guesswork
Medical billing audits are priced as a flat fee per engagement, based on provider count and sample size, confirmed before the audit begins. Every audit includes a documented findings report and a specific corrective action plan, not just a list of errors with no path forward. We do not make self-disclosure decisions on your behalf, since that is a legal determination, but we provide the quantified findings your legal counsel needs to make that call quickly and with confidence
Team
How Our Team Catches What Regular Billing Review Misses
Every practice that comes to us for an audit is usually surprised by what turns up, not because their billing team is careless, but because day-to-day claim volume rarely leaves room for the kind of structured, sample-based review a real audit requires. We start every engagement with a clearly scoped sample, so the findings are specific enough.
50 States Strong
Ready to Find Out What a Structured Audit Would Actually Show?
Start with a complimentary scoping consultation to determine the right sample size and risk areas for your practice, before committing to a full audit engagement.
Complimentary scoping consultation for your audit
Risk area review aligned to current OIG Work Plan priorities
Risk area review aligned to current OIG Work Plan priorities
Sample size and methodology recommendation specific to your provider count
No contracts, no setup fees, no upfront costs
Pay only a percentage of what CureBytes collects for you
Dedicated billing specialist assigned to your practice from day one
Dr. Michael Anderson
Office Manager
“CureBytes has made a noticeable difference in how we manage our medical billing. Their team is responsive, detail-oriented, and keeps our claims moving efficiently. We spend less time worrying about billing issues and more time focusing on our patients
Hannah Schmitt
Practitioner
“Before working with CureBytes, our staff was spending far too much time dealing with claim follow-ups and billing questions. Their team streamlined the entire process and has been excellent at keeping us informed. The service has been professional from day one.
Sarah Mitchell
Lead Operations
“CureBytes has been a great partner for our practice. From claims submission to follow-ups and payment posting, their team handles the process with great attention to detail. Their communication is consistent, and we always know what is happening with our accounts.
Dr. James Carter
Accounts Manager
“What impressed us most about CureBytes is their responsiveness. Whenever we have a billing concern, their team is quick to investigate and provide a clear update. They have helped us make our billing workflow much more organized and efficient.
Linda Roberts
It Head
“Lorem ipsum dolor sit amet, consectetur adipiscing elit. Cursus nibh mauris, nec turpis orci lectus maecenas. Suspendisse sed magna eget nibh in turpis. Consequat duis diam lacus arcu. Faucibus venenatis felis id augue sit cursus pellentesque enim
Dr. Emily Thompson
Vice Administrator
“Dr. Emily Thompson
Frequently Asked Questions
Everything You Need to Know Before You Decide
What is a medical billing audit?
Most practices treat claims 90 days or older as aged AR, with the 91-to-120-day range considered urgent and anything past 120 days considered critical, since timely filing windows are often close to expiring by that point.
What is the difference between a coding audit and a compliance audit?
We were writing off denials we didn’t even understand. CureBytes rebuilt our claims process and the money started showing up again
How many claims should be reviewed in an audit?
We were writing off denials we didn’t even understand. CureBytes rebuilt our claims process and the money started showing up again
What happens if an audit finds an overpayment?
We were writing off denials we didn’t even understand. CureBytes rebuilt our claims process and the money started showing up again
Is front office management the same as eligibility verification?
We were writing off denials we didn’t even understand. CureBytes rebuilt our claims process and the money started showing up again