Compliance Monitoring & Audit Services
Protect your practice from regulatory risk, improve revenue integrity, and stay audit-ready with OIG- and HIPAA-aligned compliance monitoring from Medical RCM.
Proactive audits
Catch issues before payers do.
PHI-secure workflows
Encrypted storage and BAAs available.
Trusted by multi-site physician groups, specialty clinics, and behavioral health networks.
Core Services
A risk-based mix of automated and manual reviews tailored to your practice.
Billing & Coding Audits
Targeted chart reviews for high-dollar codes, modifiers, and documentation gaps.
Corrective Action Plans
Prioritized remediation plans with timelines and verification.
Ongoing Claims Monitoring
Rules engine flags potential overpayments and payer mismatches pre-submission.
Provider & Staff Training
Role-based training modules for sustainable improvement.
HIPAA & Security Checks
Privacy and security posture assessments with BAAs and gap reports.
Custom Reporting & KPIs
Dashboards on denials, A/R days, and overpayment risk.
How it works
1. Discovery
Workflow mapping, top payers, and high-risk lines.
2. Baseline Audit
Targeted sampling and full-chart reviews to quantify risk.
3. Continuous Monitoring
Automated checks + targeted training to reduce recurrence.
4. Reporting & Remediation
Dashboards, executive summaries, and CAP tracking until closure.
Typical outcomes
Fewer coding errors
-45% avg.
Improved documentation and provider performance.
Reduced denials
-30% avg.
Denial reduction through rules and training (results vary by client).
Faster audit resolution
Faster
Defensible documentation and CAP tracking shorten resolution time.
FAQ
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High-risk service lines monthly/quarterly; lower-risk areas semi-annually. Continuous claims monitoring runs daily/weekly depending on volume.
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We identify root causes, create CAPs, implement remediation, and monitor until closure — we don’t just hand you a report.
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We use encrypted storage, role-based access controls, secure transmission, and execute BAAs as required.
Schedule a free compliance risk assessment and receive a tailored remediation roadmap.
• Free 30-minute discovery call
• Baseline audit with prioritized CAP
• Ongoing monitoring plans available