51 Atlantic Avenue Suite # 202, Floral Park, NY 11001 +1(212) 363-0114 Info@hcmsus.com

QUALITY FIRST

Medical Billing and Coding
Audit Services

It's Not If You'll Get Audited. It's When & What They'll Find. Your Biller Says You'reCovered. So Did the Last 47 Providers We Helped Fight a Payer Recoupment. Ourmedical billing and coding auditors audit you before the government does, catching E/Mupcoding, misuse of time-based billing, and documentation gaps that triggerclawbacks, subpoenas, or worse.

I Want an Audit Before CMS Knocks
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If You Think Clean Claims Mean You're Safe, You're Already Exposed

Billing systems can make a claim look clean. But payer algorithms don't care what your dashboard says. They're trained to spot patterns of abuse, frequency, and risk not spelling errors.

Let's get brutally honest. You submitted the claim, the EMR showed no errors, the clearinghouse passed it through, the payer reimbursed. Everything seems fine until it isn't. Payers don't flag every bad claim. They accumulate statistical patterns, watch your billing habits over time, and then strike with:

  • Prepayment audits
  • Post-payment recoupments
  • Medical necessity reviews
  • Payer-led extrapolations

We simulate payer behavior using compliance datasets, denial pattern models, and CMS audit criteria then tear through your claims like a RAC auditor would.

Doctor using phone

The Real Problem with Clean Claims:

Coding redundancy

Same procedures billed repeatedly across visits without variation-triggering utilization reviews.

Modifier misuse

Modifiers 25, 59, and 91 are the top 3 abused in U.S. billing and the most aggressively tracked by MACs.

E/M exaggerations

Spikes in high level E/Ms without complexity justification = audit bait.

Thin documentation

Claims billed without correlating HPI, time documentation, or medical necessity = immediate red flag.

Why Our Medical Billing and Coding Auditors Are Trained to Think Like Payers

Anyone can check for typos. We reverse-engineer your claim the same way CMS, MACs, and commercial payers do because your revenue depends on how they see it, not how your software does.

Our auditing process doesn't start with your billing software. It starts with payer behavior modeling, which breaks down the exact triggers that cause denials, post-payment reviews, or full-blown RAC audits.

Our team combines AI anomaly detection with manual forensic coding analysis, enabling us to identify discrepancies that your internal teams (and your EMR) may miss.

Target
92%
of providers we audited had high-risk patterns they didn't know existed
Shield
87%
passed follow-up payer audits with zero findings after remediation
Chart
98%
retention rate on our monthly audit clients
Dollar
2.3M
in recouped reimbursements found in last 12 months

Ready to Discover Hidden Revenue Risks?

Get a comprehensive audit analysis that reveals the exact patterns putting your reimbursements at risk.

Book a 1:1 Audit Discovery Call Now
Doctor using phone

Future-Facing Billing Audits for Hospitals

Most hospital finance teams review claims like forensic accountants-after the money's gone. But in 2025, CMS and commercial payers are playing a predictive game.

They're watching volume surges, diagnosis-to-CPT irregularities, and modifier stacking trends and they're not sending warnings.

Our billing audits for hospitals flip your process from reactive to predictive so you can see denials coming and outmaneuver them before the payer locks you into pre-pay reviews or worse.

Medical Billing Audit Services With Real Outcomes

Not Empty Claims

We don't just identify issues we correct revenue pathways, reduce denial rates, and engineer audit-proof workflows. See what we have been achieving so far:

CASE: Surgical Practice, NY
Alternate Text Problem:
17% of claims were denied due to Modifier 25 stacking
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Recovered $112K within 30 days; 94% appeal success
CASE: Regional Hospital System, TX
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Unexplained spike in 99215 billing, flagged by payer
Alternate Text Result:
Prevented $378K in clawbacks via retroactive documentation support
CASE: Behavioral Health Group, WA
Alternate Text Problem:
Chronic time-based code misuse with 90837s
Alternate Text Result:
Denial rate dropped from 22% - 7% within 90 days
CASE: Multi-specialty Clinic, NJ
Alternate Text Problem:
"Clean claims" hiding medical necessity risks
Alternate Text Result:
$146K recovered, 2 audits passed, zero findings

How Our Medical Billing Audits Crush Revenue Risk Before Payers Can

Forget generic workflows. This is how we dissect denial risk, expose hidden undercoding, and reroute your billing operations.

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Identify Revenue Exposure

We begin by selecting a sample of your most financially impactful claims either high-denial areas, high-volume CPTs, or flagged provider activity. Our team identifies where coding, documentation, or modifier usage may be putting revenue or compliance at risk.

Key deliverable: Pre-audit risk scan, mapped to payer denial patterns and CMS edit logic.
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Audit with Dual-Lens Accuracy

Each selected claim undergoes two levels of review:

  1. Automated detection using proprietary rules-based software
  2. Manual audit by certified coders with payer-side and specialty-specific expertise

We don't rely on systems alone-our audits capture context, not just code errors.

Key deliverable: Claim-level audit score with compliance notes and coding justification.
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Deliver Actionable Remediation Plans

You receive a prioritized report outlining:

  • Financial impact of identified issues
  • Suggested corrections for each claim
  • Documentation enhancement recommendations
  • Modifier usage guidelines by payer policy

No noise. Just high-impact actions that protect revenue moving forward.

Key deliverable: Interactive audit report with recovery roadmap.
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Implement & Monitor Results

We help you implement corrections across your internal teams or external billing partner, then monitor outcomes over the next 30-90 days.

Ongoing audits track denial reduction, recovery velocity, and documentation improvements.

Key deliverable: Post-audit impact report with measurable KPIs (denial rate, revenue lift, compliance confidence score)

Before Our Medical Coding Audit Services, You're Guessing. After? You're Diagnosing.

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What Most Providers Do
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What Happens Inside HMS USA LLC Audit Lab
Rely on EMR flags or clearinghouse edits Use CPT clustering + payer denial maps
Manually sample claims post-denial Pre-scan 1,000s of claims using AI triage
Miss silent undercoding in "safe" claims Reveal missed revenue + doc gaps
Fix errors after payers flag them Fix patterns before payers ever see them
No visibility into documentation impact Documentation scored against code risk

Real Healthcare Audit Solutions Don't Just Report. They Reinforce Revenue Integrity Daily.

Claim Submission
EMR pushes data
HMS pre-screens for audit flags in real time
Risk Scoring
AI models assign
"audit pressure index" by CPT, provider, modifier
Feedback Injection
Risk insights sent to
billing, compliance, AND clinical teams (not just coders)
Documentation Adjustment
Clinical language
updated to close gaps flagged by audit AI
Audit Re-Run and Approval
Clean claim generated
payer submitted with zero red flags

Why Hospitals, Clinics, and Group Practices Choose HMS USA LLC When Revenue's on the Line

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Most billing audits correct 1-2% of claims. Ours consistently surface 5-12%

That delta is your lost revenue reclaimed.

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We audit like a payer would, not like a vendor should.

That's how we prevent denials-not just explain them.

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We prioritize financial impact, not technical nitpicking.

Every flagged claim is tied to a bottom-line effect. No distractions.

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We embed long-term protection. Not temporary clean-up.

You get remediation + documentation fixes + coder training built-in.

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Our clients stay. Not because they have to-but because clawbacks stopped.

8% retention isn't a metric. It's proof.

What Clients Say About Us

Below, you will find feedback from some of our cherished clients. We are proud to have helped them reach their business goals, and we appreciate the kind words they have shared about our services.

DR. ADEEL IQBAL, DO
DR. ADEEL IQBAL, DO
North Ocean Medical Group, P.C
5.0 Out of 5
I have had the pleasure of working with HMS, USA LLC since 2016 as they are providing me services for both primary care/urgent care practice as well as multiple nursing homes located in NY, USA. Over the past few years, they have demonstrated strong organization, multitasking, and time management skills. Their role is to submit billing claims for all my locations, manage and report monthly income and assist with credentialing for insurance companies. They maintained accurate records for patients and effectively communicated with both patients and insurance companies to resolve outstanding matters. They are very professional in all aspects of their work.
DR. MOHAMMAD ISLAM, MD
DR. MOHAMMAD ISLAM, MD
North Orchard Medicine PC
5.0 Out of 5
I have been working with HMS USA, LLC for almost three years, and I do not recall a single instance where I have had an issue with billing, coding, credentialing, and receivables. They have an expert team who are highly diligent and correspond swiftly with all my queries. I work with Nauman Jamil, Steve Smith, and other professionals in HMS. They educate and update my staff and me with all the billing and compliance, including MIPS. I have yet to come across another billing agency that can match the level of expertise and professionalism to HMS USA, LLC. Their service is truly unparalleled and impeccable.
KEISHA KADESHA BRYANT, MD
KEISHA KADESHA BRYANT, MD
Dr. Bryant Medical Practice PC
5.0 Out of 5
HMS USA LLC has been instrumental in helping me optimize coding for my practice, and in closing the care gaps for my patients. With regular reports and updates from HMS team, I am now able to better understand my practice financials and health, and concentrate more on providing quality care to my patients.
Dr. Arshad Anwar, MD
Dr. Arshad Anwar, MD
Advanced Medical Office, PC
5.0 Out of 5
I have been using HMS medical billing services for my practice office since 2011. They have exceeded my expectations in growing my practice's revenue, and I would not hesitate to refer them to any medical practitioner looking to improve their practice's reimbursement.
Sajjad Akhtar
Sajjad Akhtar
5.0 Out of 5
Working with HMS USA LLC has been an absolute pleasure. Their team of skilled professionals is not only knowledgeable in their field but also dedicated to providing top-notch service and support. They took the time to understand our unique needs and developed a tailored solution that exceeded our expectations. We cannot recommend Zulqarnain & his billing team enough for seeking innovative solutions and exceptional customer care.
Syed Hussain
Syed Hussain
5.0 Out of 5
HMS USA has been one of the best billing companies that I have ever worked with. The entire team who I have worked with including Raja Waqas, Rashid Ali and Nauman Jamil have been very helpful every step of the way. They are knowledgeable and prompt with answers and solutions to my questions. I especially love the transparency and ease they bring in to the billing aspect of my practice. Go Team!
Fahad Riaz
Fahad Riaz
5.0 Out of 5
I can't express how impressed I am with HMS. From the moment I started using it, I knew I had found something special. The quality is top-notch, and it has exceeded all my expectations. Mr. Jamil took my call right away and guided me through what HMS offered; he and his team made credentialing a breeze. The attention to detail is remarkable, a very efficient and seamless billing process. What sets HMS apart is the outstanding customer service. The support team is incredibly responsive, knowledgeable, and goes above and beyond to ensure customer satisfaction. It's rare to find such a combination of an excellent product and exceptional customer support. Kudos to the the fantastic team - Raja Waqas, Nauman Jamil, Kamran Younis and the rest of the remarkable team who have helped me greatly during my time with HMS. I highly recommend HMS
Fatima Abbas
Fatima Abbas
5.0 Out of 5
I would like to take this opportunity to thank Raja Waqas, Kamran Younis and the CEO of HMS USA: Mr. Nauman Jamil for saving our company: Elpis Healthcare. We started our clinics back in September 2021 and went down nose-diving for almost a year due to poor billing support from two separate companies. We got introduced to HMS USA LLC in September 2022 where we were at less than half of our monthly revenue. With immense support, diligent work and countless hours - HMS USA turned our clinics around where we are no longer in the red. We are so thankful and appreciative of their efforts, their suggestions and guidance, their support in setting up our billing systems, having the right knowledge about how to code each patient, suggestions about what programs and incentives to use, has been life changing. A big shout-out to Raja Waqas and Kamran Younis - always always always there to help us at any time. Most care-giving, excellent customer support, very polite - they both go above and beyond to provide any information or data we need, provide guidance on how to fix issues with insurance companies etc. Another big shout-out to the CEO of the company: Mr. Nauman Jamil who really helped us with cleaning up the neck-high mess we were all in for over a year. Not once did he ask us to pay him for all the services he was providing for months. Once we started to make money, he sent us the first invoice upon our request. He is a true gentleman! I give their company two thumbs up! Highly recommend HMS USA! Best Medical Billing Company in whole of the United States!
Michael Khaham
Michael Khaham
5.0 Out of 5
Both the current biller in charge of my account - Tanveer Azam and the previous biller - Asad Ali who worked on my account in the past are experts in their field with extensive knowledge and experience. They have been utilizing an individualized approach to each claim. Timely submission with ongoing monitoring of responses from the insurance companies have resulted in noticeable increase in revenues. They persistently negotiate and work on various approaches to successful appeal denied claims as well. Most importantly for a novice like myself, there is a constant open line of communication between the biller and the client, keeping me in the loop and deciphering the convoluted process happening behind the scene.
Gim Li
Gim Li
5.0 Out of 5
Have been dealing with HMS for past few months, Raja Waqas and Rashid Ali are very quick and very responsive.
info psychassociatesofnorthtx
info psychassociatesofnorthtx
5.0 Out of 5
I have been with HMS for the last 5 months. Initially I was concerned about the massive transition of data from my previous billing company to HMS. HMS team made sure the transition was smooth and seamless; answered any of my concerns during transition period. They have defined excellent workflows that makes the daily tasks so easy. HMS is extremely responsive whether it’s via Microsoft Teams, or email or phone call. Very good collaboration between office front staff and HMS staff. We have monthly account review calls where we go over the reports that shows how the practice is doing. HMS is open to make tweaks to the reports based on practice recommendations. HMS take action on any insurance denials within 24 hours and provide whatever is needed to turn that denial to approval. HMS research any regulatory changes and inform out practice of such changes. They also take care of Insurance company correspondence if needed. Moin and the team are very professional, prompt and provide excellent level of service. We would highly recommend HMS for their services.
Elaine Chen
Elaine Chen
5.0 Out of 5
Asad has been a key factor in making my billing process smooth and hassle-free. Whenever I reach out with a query or request, he promptly responds with the necessary information or takes immediate action to address my concerns. His responsiveness has been invaluable in ensuring that I receive the support I need in a timely manner.
Pretam Rampersaud
Pretam Rampersaud
5.0 Out of 5
I have been using this billing company for the past 18 months and I am extremely satisfied with their work. I would gladly endorse them to anyone seeking excellent medical billing providers. I especially would like to acknowledge the work of 2 of their team - Touqeer Shah and Nabeel Sheraz UPDATE: 11/16/23 I have used HMS, USA for the past few years and each year has been a great year, with the following year surpassing the previous year. I always get timely feedback on my inquiries. I have always had any issues resolved, once again, in a timely manner. I would highly recommend HMS to any of my colleagues as they have enhanced my revenue stream.
Mona Hussien
Mona Hussien
5.0 Out of 5
If there is an option to give them 10 stars I would agree. HMS USA is an excellent choice for medical practitioners looking for a reliable and efficient medical billing service. They provide comprehensive billing solutions. From insurance verification to claim submission and follow-up. They really ensure that their clients receive maximum reimbursement for their services. Another notable aspect of HMS is its exceptional customer service. They are always available to answer any questions or concerns that their clients may have, and they go above and beyond to ensure that their clients are satisfied with their services. Many Thanks to Khurram and his team for their excellent service.
Umar Latif
Umar Latif
5.0 Out of 5
I transitioned to HMS 5 months ago and it has been a remarkable experience. The organization is run very professionally with sophisticated operations that lead to highly efficient processes. Great team collaboration and responsiveness. Onboarding was great. Reporting is also advanced. I would highly recommend them to help support your practice.
North Ocean Medical Group, P.C
North Ocean Medical Group, P.C
5.0 Out of 5
My primary care office has been working with HMS team for the past 5 years. We recommend this company with no hesitations. They work diligently and efficiently to manage our account. Raja Waqas and Kamran Younis provide high quality service communicating on a daily basis with ownership. They ensure that the work is being done in a timely manner. They have a proven track record of increasing practice revenue as I have seen them do it with our primary care. Raja and Kamran provide exceptional customer service along with their team.
Lubna Siddiki
Lubna Siddiki
5.0 Out of 5
I would highly recommend HMS billing services due to their impeccable work flow. The staff is highly professional and courteous to our practice and responds in a timely manner. We have been able to keep our practice running smoothly due to close collaboration between the front desk staff and the billing company. Moin and his team mates are doing an awesome job !!! Special thanks to Nauman Jamil for putting it all together.
Nazia Iqbal
Nazia Iqbal
5.0 Out of 5
Our office has been working with the HMS Team C for the last 5 years and we are highly satisfied with their quality of work. Their team communicates effectively with my front staff as well as with ownership. Raja Waqas and Kamran Younis have managed our large census for both our offices and nursing home facilities with ease. They have increased our revenue by educating us on different programs as well as billing codes that we initially were not incorporating. We highly recommend this company when starting your own medical practice as they assist with billing, coding, credentialing, prior authorizations/referrals and more.
North Orchard Medicine
North Orchard Medicine
5.0 Out of 5
I've been working with HMS for over two years, and they have entirely transformed my medical practice. Not only have they increased my revenue, but they've also helped me to streamline my operations and become more efficient. The administration is fantastic as they respond so efficiently! They are professional and always ensure that all of my billing needs are taken care of. They work against the clock to get the work done, and I couldn't ask for anything more. HMS is the perfect choice if you're looking for an exceptional medical billing company.
Ghulamullah Shahzad
Ghulamullah Shahzad
5.0 Out of 5
Excellent company .not only in In Network claims but Experts in out of network claims. I have changed 4 companies to settle on this one. Very nice and courteous staff Especially Ahsan and Arif Muttee, Tahzeeb, I am specialist and referred them few clients they are very happy with the service.
usman khan
usman khan
5.0 Out of 5
It is going to be almost a year I have been working with HMS for my practice. I have to say they have simplified a complicated process. The whole team has been helpful in growing my practice and relieving me of any unnecessary stress. They are professional and always ensure that all of my billing needs are taken care of. I want to acknowledge Mr. Zohaib Syed for not only his professionalism, but also for being patient with me and explaining to me the whole process. I would, without hesitation, recommend HMS to anyone requiring a billing company.

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