Medical billing audit services for operators who keep their billing.

An RCM firm takes over your billing operation and charges per claim or a percentage of collections — an operating cost that never ends. A medical billing audit from Zaigo finds where revenue leaks, then encodes your exception rules into AI your own team runs. Your billers keep the workflow, the payer relationships, and the margin; the system catches what they cannot get to.

No. Your team keeps billing end to end — the software, the clearinghouse, the payer relationships. We audit the leakage and build the checks inside your existing flow: denials triaged, underpayments flagged at posting, exceptions queued for your billers. Nothing about who bills changes; what changes is how much gets caught before it writes off.

Specialty billing is where encoded rules pay back fastest, because the exceptions are the job. DME billing services run on documentation and rental-cap rules; anesthesia billing services on time units and concurrency; home health billing services on episode and plan-of-care rules; hospice billing services on per-diem and cap accounting. The audit maps those rules exactly, per payer, before anything gets built.

Read access to your remits and claim feed, your payer contracts and fee schedules, and two hours a week with whoever knows the exceptions. No new system to adopt, no workflow change during the audit. Two weeks, fixed fee — you get the rule map, the measured leakage, and a priced build plan before you commit to anything.

Whatever the audit ranks first. Typical builds: denial-triage automation that routes denials by root cause, underpayment detection that checks every remit line against contracted rates at posting, and a payer-rule engine that absorbs quarterly payer edits. Each build is scoped per workflow with a payback estimate up front — the audit fee credits toward the first one.

Ownership and handover terms are set in the agreement. The handover includes the documented rules and code in scope, with the hosting, credentials, third-party services, and ongoing support needed to keep it running.