Recover Lost Revenue with Expert Medical Billing
Audit Services
Revenue Performance Review
When claims are delayed, denials repeat, or payments do not match the work performed, your revenue cycle needs a closer review. The Hamill Group provides RCM audit services to identify billing gaps, underpayments, and A/R issues before they become long-term losses.
97%
Clean Claim Rate
100%
Compliance-Focused
Audit Process
Payment Variance Check
Claims, denials, payments, and billing workflows by experts
How Our RCM Audit Process Reviews and Prioritizes Revenue Gaps
Patient Access & Registration
Patient details, insurance coverage, eligibility, authorizations, and upfront collection steps are verified.
Validate Coding & Documentation
Charge Capture & Claim Submission
Rendered services, entered charges, clean claim rate, payer edits, and claim readiness are checked.
Denial Management Analysis
Accounts Receivable (A/R) & Payment Posting
Compliance & Action Plan
Make Every Claim, Payment, and Balance Easier to Trace
Most practices do not need another billing report. They need someone to read the problem signs inside it. The Hamill Group turns claim data, denial activity, payment behavior, and A/R movement into a clear view of where revenue is being delayed or missed. Our medical billing audit services help leaders understand which issues need attention first, which payer patterns affect cash flow, and which workflow gaps create recurring problems. Instead of leaving your team with scattered numbers, our RCM audit provides a practical action plan for cleaner claims, stronger follow-up, and better revenue control.
How THG RCM Audit Findings Improve Revenue Control
Why The Hamill Group Looks Beyond Billing Errors
Strong revenue performance depends on more than getting claims submitted. Your practice also needs billing records, payment decisions, denial responses, and write-offs that can be explained with confidence. The Hamill Group helps healthcare leaders bring more control to those decisions through structured RCM audit services. Every finding is organized to support better oversight, stronger internal accountability, and better preparation before payer questions.
RCM Audit Services for Specialty Practices
Specialty claims are not denied for the same reasons. A cardiology test, behavioral health visit, surgery claim, or DME order each carries different coding rules, authorization needs, and payer checks. The Hamill Group audits these specialty-specific risks so practices can find the issues affecting payment.
Do Not Let Payers Be the First to Find the Problem
- Audit scope matched to your practice
- Clear starting point for investigation
- No pressure, no long commitment
- Built for healthcare revenue leaders
Deliverables From Our Medical Billing Audit Services
Revenue Leakage Summary
A clear breakdown of where revenue is being delayed, missed, underpaid, or written off without proper visibility.
Denial Root-Cause Report
Recurring denials are grouped by payer, code, and billing step so your team can see what keeps failing.
A/R Aging Breakdown
Open balances are sorted by age, payer, and follow-up risk to show which accounts need faster action.
Payment Variance Findings
Underpayments, incorrect adjustments, and contract mismatches are flagged to identify reimbursement gaps.
Coding Risk Notes
Coding, modifier, and documentation concerns are listed in simple terms to reduce future claim errors.
Corrective Action Roadmap
Audit findings are translated into clear priorities, workflow improvements, and next steps to strengthen revenue control.
When Your Practice Needs an RCM Audit
Denials keep returning without a clear cause.
Payments slow down across specific payers.
Write-offs increase without leadership visibility.
What Healthcare Providers Say About Our RCM Audit Services
North Orthopedic Care
We thought one commercial payer was simply paying according to the contract. The audit showed a consistent underpayment pattern across several procedure codes. They compared our EOBs, fee schedule, and posting records and then provided us with a clear appeal file.
Lakeside Gastroenterology Group
Our orthopedic claims kept being denied for modifier issues, but the pattern was hard to see internally. THG audited our CPT/modifier use by payer and found that documentation did not support the billed service. Their correction plan helped our billing team reduce repeat rework.
BrightPath Behavioral Health
Summit Cardiology Associates
Harborview Family Medicine
Frequently Asked Questions
What is included in The Hamill Group’s medical billing services?
Our medical billing services cover eligibility checks, VOB, charge review, CPT/ICD-10/HCPCS validation, 837 claim submission, clearinghouse rejection correction, 835 ERA posting, denial management, AR follow-up, secondary billing, and KPI reporting.
How is THG different from a generic medical billing company?
Most billing companies submit claims and follow up after problems happen. THG manages the revenue cycle workflow behind the claim, including front-end controls, payer-specific edits, denial root-cause analysis, AR segmentation, and executive reporting.
Does THG support both professional and institutional claim workflows?
Yes. THG can support professional and institutional billing workflows where applicable, including 837P/837I claim submission, payer edits, payment posting, denial routing, and AR follow-up.
How does THG reduce preventable claim rejections?
We review claims before submission for NPI, taxonomy, POS, modifiers, diagnosis pointers, subscriber details, COB sequencing, authorization linkage, payer edits, and documentation gaps.
Can THG work with our internal billing team?
Yes. THG can work with internal billing teams, Physicians, Coders, front-desk staff, Accounts Managers, administrators, and leadership to improve claim ownership, payer follow-up, and revenue visibility.
Why does behavioral health billing require specialized workflows?
Behavioral health billing includes recurring visits, VOB, prior authorizations, telehealth rules, session-level CPT coding, H-code workflows, medical necessity documentation, and payer-specific carve-outs. These workflows need tighter control than standard billing.
What behavioral health services does THG support?
THG supports billing for therapy, psychiatry, counseling, group therapy, SUD, IOP, PHP, telehealth visits, and multi-provider behavioral health organizations.
How does THG manage behavioral health authorizations?
We track authorization numbers, approved units, CPT/HCPCS codes, provider details, date ranges, payer rules, documentation requests, re-authorization deadlines, and concurrent review needs.
Does THG support telehealth billing for behavioral health?
Yes. THG reviews telehealth claims for POS 02/10, modifiers 95, GT, or GQ where applicable, payer-specific rules, documentation support, authorization status, and session-level coding accuracy.
How does THG prevent repeat behavioral health denials?
We classify denials by CARC/RARC, payer, CPT, provider, authorization status, service line, documentation issue, and workflow source to identify whether the root cause is VOB, authorization, coding, documentation, or payer policy.
How is pricing for THG’s billing services determined?
Pricing depends on specialty, claim volume, payer mix, provider count, number of locations, EHR/PM setup, denial volume, AR cleanup needs, credentialing scope, reporting requirements, and service complexity.
Does behavioral health billing have different pricing?
It may, because behavioral health often requires deeper VOB, recurring authorization tracking, telehealth validation, H-code support, session-level review, and payer-specific documentation management.
Is AR cleanup included in standard pricing?
Aged AR cleanup is usually reviewed separately because old claims require denial analysis, timely filing checks, payer status review, appeal validation, underpayment review, and recoverability scoring.
Do you offer pricing based on collections?
Pricing can be structured based on the client’s scope, volume, specialty, and revenue cycle needs. Final pricing is confirmed after reviewing claim volume, payer mix, AR status, EHR setup, and workflow complexity.
What should we review before requesting a quote?
Review your claim volume, denial rate, AR over 90 days, payer mix, provider count, authorization volume, EHR limitations, credentialing gaps, and reporting needs. These factors affect the scope and pricing model.
Do we need to change our EHR to work with THG?
Our medical billing services cover eligibility checks, VOB, charge review, CPT/ICD-10/HCPCS validation, 837 claim submission, clearinghouse rejection correction, 835 ERA posting, denial management, AR follow-up, secondary billing, and KPI reporting.
What parts of the EHR workflow does THG review?
Our medical billing services cover eligibility checks, VOB, charge review, CPT/ICD-10/HCPCS validation, 837 claim submission, clearinghouse rejection correction, 835 ERA posting, denial management, AR follow-up, secondary billing, and KPI reporting.
How does THG identify EHR-to-clearinghouse issues?
Our medical billing services cover eligibility checks, VOB, charge review, CPT/ICD-10/HCPCS validation, 837 claim submission, clearinghouse rejection correction, 835 ERA posting, denial management, AR follow-up, secondary billing, and KPI reporting.
Can THG help with 835 ERA posting issues?
Our medical billing services cover eligibility checks, VOB, charge review, CPT/ICD-10/HCPCS validation, 837 claim submission, clearinghouse rejection correction, 835 ERA posting, denial management, AR follow-up, secondary billing, and KPI reporting.
Does THG support documentation or medical transcription handoff issues?
Our medical billing services cover eligibility checks, VOB, charge review, CPT/ICD-10/HCPCS validation, 837 claim submission, clearinghouse rejection correction, 835 ERA posting, denial management, AR follow-up, secondary billing, and KPI reporting.
How does THG protect PHI during billing operations?
THG follows compliance-focused workflows that support role-based access, secure documentation, PHI handling controls, payer record management, BAA requirements where applicable, and audit-ready billing notes.
Does THG work with HIPAA billing transaction standards?
Yes. THG works around HIPAA-related billing workflows, including 837 claim submission, 835 ERA posting, 270/271 eligibility, 276/277 claim status, and 278 authorization/referral workflows where applicable.
How does THG support payer audit readiness?
THG can help organize claim notes, payer communication, appeal documentation, authorization records, EOB/ERA files, denial history, and supporting documentation needed for payer audit response.
How does THG reduce compliance risk in billing workflows?
We review coding alignment, documentation support, payer requirements, authorization status, provider setup, billing notes, payment adjustments, and repeat denial patterns to reduce preventable exposure.
Can THG publish HIPAA, ISO, CPB, or RHIA certification claims?
Only if verified documentation is available. Safe website wording is HIPAA-aware processes, ISO 27001:2022-aligned controls, CPB-aligned billing workflows, and RHIA-informed documentation standards unless formal proof is confirmed.
Stop Losing Revenue Start With a Free Audit
- Free 30-minute scoping call.
- Custom scope within 48 hours.
- Certified CPC and CPMA auditors.
- HIPAA-compliant from day one.