Medical billing audit services for operators who keep their billing.
A two-week audit finds where denials, underpayments, and exception queues leak revenue — then we encode your billing rules into AI your team runs.
Official services partner of the platforms defining AI
NVIDIA
Anthropic
The denial queue is underwater. The underpayments nobody sees.
From billing companies and provider-group back offices we have sat inside: thousands of claims a week, with the exception rules living in three people’s heads.
Denials worked one at a time, never as a pattern
Every denial gets reworked by hand; nobody totals them by payer, code, or reason. The same root cause writes off revenue every week.
Underpayments posted as paid in full
The remit comes back short of the contracted rate and posts anyway. Catching it means knowing every payer’s fee schedule, claim by claim.
The exception queue runs on three people
Anything unusual waits for the biller who knows the rule. When they are out, the queue stalls; when they leave, the rule leaves.
Payer rules change faster than the memo
Timely-filing windows, modifier edits, bundling rules — every payer ships changes quarterly, and the update sits unread while claims keep denying.
The outsourcing pitch starts to sound reasonable
When the queue is underwater, handing billing to an RCM firm looks like relief — until the percentage and the lost visibility land.
The leak is a line item, not a feeling.
We do not quote industry denial rates — easy to inflate, useless for your decision. The two-week audit measures your remits before anything gets built.
From anonymized provider-group and billing-company engagements — no invented error rates
We encode your exceptions.
No new system for your team to learn. The rules your best biller carries in their head become the audit.
- 01
Map the rules
We write down every rule a claim gets judged by: payer contracts, fee schedules, denial history, exception logic. Tribal knowledge becomes a rule set — yours to keep.
- 02
Encode the audit
Every claim and remit line gets checked against your rules. Denials route to triage, underpayments get flagged at posting, payer edits land in one review queue.
- 03
Run it every week
Denial-triage automation, underpayment detection, and a payer-rule engine keep pace with the queue. Your team reviews violations, not every claim.
RCM firms take over your billing. We encode your rules so you keep it.
RCM firms want the whole billing operation — per-claim fees or a percentage of collections, forever. Your payer knowledge, your rules, and your margin leave the building with it.
We are not that. The audit finds the leakage; the build encodes your exception rules into AI your own team runs — denials, underpayments, and payer edits caught inside your shop.
Led by Peter Enestrom.
Asked by billing operators and practice executives.
The straight answers, before you book anything.
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.
You do. The rule set — payer contracts, exception logic, denial playbooks — is documented and handed over, and anything we built keeps running inside your systems. There is no lock-in designed into the work, and no percentage of your collections at any point.
Start with one workflow.
Tell us where your team loses hours. We will come back with a straight answer on whether AI can help, what it would take, and what it would pay.