What Does the Audit Review?
The audit covers six areas of your revenue cycle. Each area produces a number you can compare with eye care benchmarks.
| Area | What we measure | Benchmark |
|---|---|---|
| Collections | Net collection rate | 95% or higher |
| Cash speed | Days in A/R and A/R aging by payer | Under 35 days, under 15% over 90 days |
| Claim quality | Clean claim rate and top rejection reasons | 95% or higher |
| Denials | Denial rate and top 10 CARCs with dollar values | Under 5% |
| Coding patterns | Exam and E/M level spread, modifier 25 use on injection days, laterality errors | Compared with national ophthalmology patterns |
| Payments | Payer rates as a percentage of Medicare and underpayments | Contracted rates |
Your Written Audit Report
The report is written for a practice owner or administrator, not for a billing specialist. It runs 6 to 10 pages and has four parts.
- Scorecard. Your six key numbers beside eye care benchmarks.
- Revenue at risk. The dollar value of open denials, aging claims near filing limits and underpayments.
- Top three fixes. The changes that would recover the most money soonest, with who would do each one.
- Compliance notes. Coding patterns that could attract payer or OIG review, such as modifier 25 use on injection days.
How Do You Request an Audit?
Requesting the audit takes about two minutes. Fill in the form on this page. We reply within one business day with a business associate agreement and a short list of reports to export. Once we receive the data, the written report follows within 10 business days. Please do not send patient information through the form itself.
Which USA Eye Care Practices Does the Audit Help?
Any eye practice in the USA can use the audit, but it is most useful in five situations.
- Collections have dropped and nobody can say why
- Your current billing company or team does not report net collection rate or days in A/R
- You are adding injections, MIGS or an ASC and want the billing checked first
- You are buying or merging with another practice
- You are deciding between in-house and outsourced billing
What Happens After the Audit?
You decide. Some practices hand the report to their own team. Others ask us to fix one area, such as A/R recovery or denial management. Others move their full revenue cycle to us. If you do work with us, the audit becomes the starting line for our monthly reports, and pricing is set from the numbers it produced. See our pricing models for more detail.