Hospice and Home Health Billing Audits
An independent claims accuracy review and compliance risk review, built specifically around hospice and home health billing requirements, to find issues before Medicare does.
Why Billing Audits Matter
Most agencies don’t know where their billing risk actually sits until an external audit finds it. A medical billing compliance audit performed proactively identifies documentation gaps, coding errors, and reimbursement issues while they’re still correctable, rather than after Medicare has already flagged a claim or requested repayment. A revenue cycle audit also frequently uncovers recoverable revenue sitting in aging accounts receivable that internal teams haven’t had time to fully work.
What Our Billing Audit Services Cover
A billing audit isn’t a single check. It moves through several layers, from individual claims accuracy to broader compliance risk and accounts receivable, each surfacing a different type of issue. The sections below break down exactly what Excellence Billing reviews at each stage of a billing audit.
- Claims Accuracy Reviews. A claims accuracy review examines a sample or full set of submitted claims against payer requirements, checking that coding, documentation, and billing amounts align correctly. Excellence Billing identifies discrepancies between what was billed and what documentation supports, flagging patterns that could affect future claims if left unaddressed.
- Documentation and Coding Review. Documentation and coding errors are a common source of denials and compliance exposure, even when clinical care was delivered appropriately. Excellence Billing reviews clinical and billing documentation against coding accuracy standards, identifying gaps between what was documented and what was billed.
- Reimbursement Analysis. A reimbursement analysis compares actual payments received against expected reimbursement under Medicare, Medicaid, or commercial payer rates. Excellence Billing identifies underpayments, missed reimbursement opportunities, and discrepancies that may otherwise go unnoticed in routine payment posting.
- Denial Pattern Identification. Recurring denials usually point to a specific, fixable cause, whether that’s a documentation gap, a coding pattern, or a timing issue tied to certification or recertification. Excellence Billing analyzes denial history to identify these patterns and provides specific findings rather than a general summary of denied claims.
- Compliance Risk Review. A compliance risk review evaluates billing and documentation practices against CMS requirements to identify exposure before it becomes an audit finding. Excellence Billing structures this review around the standards an external Medicare audit would actually apply, rather than a general compliance checklist.
- Accounts Receivable Review. Aging accounts receivable often contains recoverable revenue that internal teams haven’t had bandwidth to fully pursue. Excellence Billing reviews outstanding accounts receivable to identify claims still worth pursuing, distinguishing them from balances that are unlikely to be recovered.
- Corrective Action Recommendations. An audit is only useful if it leads to specific next steps. Excellence Billing provides corrective action recommendations tied directly to audit findings, whether that means adjusting a documentation process, correcting a coding pattern, or resubmitting a specific set of claims.
Frequently Asked Questions
- What is included in a hospice or home health billing audit? A billing audit typically includes a claims accuracy review, documentation and coding review, reimbursement analysis, denial pattern identification, compliance risk review, and accounts receivable review, followed by corrective action recommendations.
- How is a billing audit different from ongoing billing management? A billing audit is a one-time, independent review of existing billing practices and claims. Ongoing billing management is a continuous service where Excellence Billing handles claims submission and follow-up on an ongoing basis. Agencies can use an audit as a standalone service or alongside hospice billing or home health billing management.
- Can a billing audit be done without switching billing providers? Yes. A billing audit is an independent review and does not require an agency to change its current billing provider or process.
- What does a compliance risk review look for? A compliance risk review evaluates documentation, coding, and billing practices against CMS requirements to identify exposure that could surface during an external Medicare audit.
- How often should an agency have a billing audit performed? There is no fixed requirement, though agencies often benefit from a periodic audit, particularly after significant growth, staff turnover in billing roles, or a noticeable increase in claim denials.
