Billing Audits and Consulting for Medical, Dental, and Behavioral Health Practices

Running a private practice means balancing patient care with the business side of medicine. At Maximum Billing, LLC, we help private practices maximize revenue and reduce administrative burden through dedicated billing services, thorough billing audits, and proactive billing consultancy tailored to your specialty.

Private Practice Billing Services

Our end-to-end billing services handle claim submission, payment posting, denial management, and patient invoicing so your team can stay focused on care. We work to improve clean-claim rates, accelerate reimbursement, and give you clear visibility into your revenue cycle.

Comprehensive Billing Audits

A billing audit uncovers missed revenue, coding errors, and compliance risks before they become costly problems. Our team reviews your claims, documentation, and coding practices to identify gaps and provide a clear action plan to recover and protect revenue.

Proactive Billing Consultancy

Beyond day-to-day billing, our consultants help you build stronger processes. From fee schedule analysis and payer contract review to staff training and workflow optimization, we partner with you to strengthen the financial health of your practice for the long term.

What a Billing Audit Looks At

A billing audit compares three things that should agree and often do not: what the clinician documented, what was coded and billed, and what the payer actually paid. We review a sample of claims for each clinician and payer, and we look at the patterns behind them, not just the individual errors.

• Coding against documentation. Whether each code, modifier, and unit is supported by the note, and whether services that were documented were never billed.
• Payer rules. Place of service codes, telehealth modifiers, authorization requirements, and frequency limits, checked against each payer’s current policy rather than a generic rule.
• Denials and rejections. Which reasons repeat, which were appealed, and which were written off without anyone looking.
• Payments against contracts. Whether allowed amounts match your fee schedules, so underpayments are caught instead of posted as paid.
• Timely filing and aging. Claims close to a filing deadline, and balances that have aged past the point where they can still be collected.
• Patient balances and credits. Copays and deductibles collected correctly, and credit balances that may be owed back to patients or payers.

Coding and Documentation Review by Specialty

Behavioral health

Psychotherapy codes are time based: 90832 covers 16 to 37 minutes, 90834 covers 38 to 52, and 90837 covers 53 minutes or more, so the documented time has to support the code billed. We also check add-on codes such as interactive complexity (90785), psychotherapy billed with an evaluation and management visit, group and family codes, and the place of service and modifiers used for telehealth sessions. Our therapy billing services page covers the day-to-day side of this.

Dental

Dental audits focus on CDT coding and the attachments payers expect. Scaling and root planing (D4341 and D4342), crowns, and other major services are frequent downgrades or denials when periodontal charting, radiographs, or narratives are missing. We also look at frequency limits, alternate benefit downgrades, and coordination of benefits between dental and medical plans. See our dental billing services for more on how we handle those claims.

Medical

Since 2021, office and outpatient evaluation and management visits have been coded on medical decision making or total time, and many practices still code by habit. We review E/M level distribution by clinician, modifier 25 on same-day procedures, and whether diagnosis codes support medical necessity for what was billed.

The Revenue Side of an Audit

Compliance is only half of an audit. The other half is money the practice has earned and not collected. We quantify denied claims that are still appealable, underpayments against your contracted rates, and aged balances still inside filing limits, and we separate what is recoverable from what is not. When the findings point to a larger backlog, our accounts receivable management and claims denial management services can work it.

Compliance: What the OIG and CMS Expect

The HHS Office of Inspector General’s General Compliance Program Guidance, published in November 2023, lists risk assessment, auditing, and monitoring as one of the seven elements of an effective compliance program, alongside written policies, training, and corrective action. A periodic billing audit is the practical way a small practice meets that element.

Audits also matter because of the Medicare overpayment rule: once a provider identifies an overpayment, it generally has 60 days to report and return it. Since January 1, 2025, that deadline can be suspended for up to 180 days while the provider carries out a timely, good-faith investigation of related overpayments. If an audit finds claims that were overpaid, we document them and flag them to you promptly so you can decide on refunds with your compliance advisor or attorney.

Every audit is handled under a signed Business Associate Agreement. Our HIPAA compliant billing services page explains how we handle protected health information.

How an Audit Works

1. Scope. We agree on the clinicians, payers, services, and date range to review, and on whether the focus is compliance, revenue, or both.
2. Sample and data. We pull claims, remittances, and the matching documentation from your practice management system or EHR.
3. Review. Each claim is checked against the note, the payer’s rules, and the payment received.
4. Findings. You receive a written summary of what we found, by clinician and by payer, with the revenue involved.
5. Action plan. We rank the fixes by impact: claims to correct or appeal, coding habits to change, and workflow gaps to close.
6. Follow-up. If you want, a later review confirms that the changes stuck and the same errors stopped.

Consulting Beyond the Audit

Many audit findings trace back to a process rather than a person. Our consulting work addresses those processes directly:

• Fee schedule analysis to see how your rates compare across payers and where contracts are worth revisiting.
• Payer contract review before you sign or renew, including rates, filing limits, and telehealth terms.
• Front desk and billing staff training on eligibility checks, authorizations, and clean claim habits. Our insurance verification services page covers the front-end checks in detail.
• Workflow reviews for charge capture, claim scrubbing, and denial follow-up.
• Credentialing checks when claims deny because a clinician or location is not enrolled correctly. See credentialing and payer enrollment.

For the full picture of how these pieces fit together, see our revenue cycle optimization service.

When to Schedule a Billing Audit

• Denials are rising, or the same denial reasons keep coming back.
• Days in accounts receivable are creeping up.
• You added clinicians, services, a location, or a new payer.
• You changed EHR, practice management system, or billing staff.
• A payer has requested records or started a review.
• It has been more than a year since anyone checked coding against documentation.

Frequently Asked Questions

Is a billing audit the same as a payer audit?

No. A payer audit is initiated by an insurer to recover money. A billing audit is one your practice commissions to find and fix problems first, including revenue you are owed.

Do you audit practices that do their own billing?

Yes. An audit is useful whether billing is done in-house, by another company, or by us, and it is often the first step before a practice decides whether to outsource.

What do you need from us?

Access to claims and remittance data for the period being reviewed, and the matching clinical documentation. We work inside the system your practice already uses.

Which practices do you audit?

Medical, dental, and behavioral health practices, including therapy groups and solo clinicians, in the twelve states where we work: Colorado, Connecticut, Florida, Georgia, Illinois, Missouri, New Jersey, New York, North Carolina, Pennsylvania, South Carolina, and Texas.

Why Choose Maximum Billing, LLC

• Specialized expertise across medical, dental, and behavioral health billing
• Transparent reporting and measurable revenue improvements
• Compliance-focused audits that reduce risk
• Personalized consultancy tailored to your practice

Contact Maximum Billing, LLC today to learn how our billing services, audits, and consultancy can optimize your private practice.

If you would rather not carry billing in-house, see our billing services for practices in twelve states.