Auditing & Compliance Reviews

We conduct structured auditing and compliance reviews for substance use disorder and behavioral health providers to identify risk, prevent revenue leakage, and strengthen operational integrity.

Our audit frameworks are informed by hands on experience in highly regulated payer environments, including California and Florida, where documentation precision and contract adherence are critical.

Proactive Risk Identification

Revenue loss and compliance exposure often stem from documentation gaps, coding inconsistencies, or authorization misalignment. We conduct systematic reviews to identify vulnerabilities before they escalate into denials, clawbacks, or audits.

Coding & Billing Audits

We review coding accuracy, charge capture processes, and claim submission patterns to ensure alignment with payer standards and clinical documentation.

Our audits evaluate:

• CPT and modifier accuracy
• Level of care consistency
• Documentation support for billed services
• Claim rejection trends

Authorization & Documentation Audits

We assess whether services billed are properly supported by medical necessity documentation and authorization timing.

This review strengthens appeal positioning and reduces future denial risk.

Contract Compliance Reviews

We evaluate payer performance against contractual terms to identify:

• Underpayment trends
• Rate discrepancies
• Authorization deviations
• Improper denials

When discrepancies are identified, we support structured recovery efforts.

Pre & Post Payment Audits

We conduct both preventative reviews before claims are finalized and retrospective reviews after payment to identify patterns and corrective actions.

Strengthening Revenue Integrity & Compliance Confidence

Regular auditing creates accountability, protects against payer disputes, and supports sustainable operational growth.