Get Your Free Fertility Billing Audit
Find out exactly how much revenue your practice is leaving on the table. Our free audit covers:
- ✓Denial rate analysis by payer and procedure
- ✓A/R aging bucket breakdown
- ✓Coding accuracy spot-check for key IVF procedures
- ✓First-pass clean claim rate vs. industry benchmark
- ✓Payer mix and contractual adjustment review
- ✓Specific, actionable improvement opportunities
Request Your Free Audit
What to expect during your audit
Short answer: submit the form, hear back inside 1 business day with a data-request checklist, and receive a written findings summary 3–5 business days after you share the reports. Your data stays with you — no EHR migration, no PM swap, no obligation to continue.
- Day 0
Request submitted
You send the form (or call (888) 822-2125). Every audit request is routed to a senior biller, not a sales rep.
- Day 1
Scoping reply
You get a data-request checklist covering denial summary, A/R aging, and payer mix. No EHR access required.
- Days 2–5
We work the numbers
We pull denial-reason mix by CARC and CPT category, aging by bucket, first-pass yield, and payer-specific loss patterns.
- Day 6+
Findings walkthrough
A 30-minute call to review the written report. You leave with prioritized recovery targets whether or not we ever work together.
What the written audit report covers
Short answer: six sections, each with a specific number, a plain-English explanation of what is driving it, and a concrete next step. Every finding maps to a workflow the practice already owns — the report is written for a billing lead, not for a slide deck.
Denial-reason mix
Distribution of denials by CARC and RARC — CO-197 “precert absent,” CO-15 “authorization number missing,” CO-11 “diagnosis inconsistent with procedure,” CO-4 “modifier missing or invalid,” and CO-50 “not medically necessary” — split into the share that is preventable at intake versus recoverable through appeal.
A/R aging by bucket
Dollars in 0–30 / 31–60 / 61–90 / 90–120 / 120+ day buckets against the HFMA MAP-Key benchmark of ≤15–25% in >90-day AR. Buckets are cross-referenced to payer timely-filing windows so nothing ages past the deadline.
Coding accuracy spot-check
Sample review of billed ART procedures — retrieval (58970) with ultrasound guidance (76948), transfer (58974/58976), embryo culture and freeze (89250/89258), and PGT biopsy (89290/89291) — checked for correct modifier use and component-vs-global billing patterns.
First-pass clean-claim rate
Percentage of claims paid on first submission with no rework. HFMA benchmark for a healthy fertility practice is ≥90% first-pass yield and ≥97% net collection rate. Anything below is dollarized as annualized leakage before the appeals workflow is even considered.
Payer mix and contract variance
Share of gross charges by payer with contracted-vs-paid variance. Frequently surfaces underpayments on Progyny, Aetna, and UnitedHealthcare panels where the fee schedule loaded in the PM does not match the executed amendment.
Prioritized recovery targets
Ranked list of the top revenue-recovery opportunities in your data — recoverable claims, correctable submission errors, and workflow changes that would prevent the recurring denial patterns we found. Each line is dollarized and dated so nothing sits without an owner.
What to have ready
Short answer: three summary reports and one optional sample export. You do not need to grant EHR access, and you do not need to prepare anything in a specific format — whatever your practice management system exports natively is fine. If your PM cannot pull one of these, tell us on the scoping call and we will work with what you have.
- Denial summary — last 90 days
Claim-level denial detail with CARC / RARC codes and payer. A denial-log export from the PM, an 835 remittance batch, or a canned denial report all work.
- A/R aging by payer
Standard bucket report (0–30 / 31–60 / 61–90 / 90+ or 90–120 / 120+). Include the pending-vs-denied breakdown if your PM supports it.
- Payer mix by charges
Gross charges by payer for the trailing 12 months, or as far back as your PM allows. Contract fee schedules if you have them exported — helpful, not required.
- Optional: one week of claim exports
A sample-week 837 or claims export lets us spot-check coding accuracy on live cases without needing standing EHR access.
All exchanges happen under a signed HIPAA Business Associate Agreement. Nothing leaves your control without your sign-off, and the audit does not require access to your practice management system or EHR.
Audit FAQs
We review your current denial rates, A/R aging buckets, coding accuracy for key ART procedures, payer mix analysis, and first-pass clean claim rate. You receive a written summary with specific improvement opportunities — at no cost and with no commitment to use our services.
The initial audit typically takes 3–5 business days after we receive access to your billing data or reports. We then schedule a 30-minute walkthrough call to present findings.
Not necessarily. A summary export of your billing reports (denial summary, A/R aging, payer mix) is sufficient for the initial audit. We'll let you know exactly what we need after your initial inquiry.
None whatsoever. The audit is a genuine free service. We believe that once you see the specific revenue opportunities, you'll want to partner with us — but there is zero pressure.
We respond to all audit requests within 1 business day. If your need is urgent, call us directly at (888) 822-2125.
Yes. Many practices transition gradually — we can start with one service line or work in a parallel audit role before a full transition.