AI Medical Billing Audit
A Faster and More Accurate Way to Audit
Manual billing audits typically happen after billing is finished, which means problems are found only once claims are denied or rejected. AI-based medical billing audits work differently. Rather than reviewing issues after they arise, AI monitors billing activity and claim patterns in real time from the moment billing starts.
How AI-Based Billing Audits Work
Based on our years of experience in medical billing, we built an AI audit engine that works with our ARM tools to make audits faster and more accurate. Here’s how it works.
- The engine connects securely with existing billing, coding, and documentation systems. It works with current workflows and does not change how teams work.
- It keeps reviewing billing activity on an ongoing basis. The review is based on payer rules, patient data, coding rules, and past claim outcomes to understand patterns and risk areas
- When something looks off, the system flags it for review. These are usually the same issues that lead to denials, billing errors, or RCM problems.
- Over time, the engine learns from human reviewers. What reviewers accept or reject is used to improve accuracy and reduce false positives.
Key Revenue Cycle KPIs We Track
Point-of-Service (POS) Collections
Patient payments collected at the time of service.
Charge Capture
Ensures all billable services are captured accurately and on time.
Clean Claim Rate
Claims accepted by payers on first submission.
Denial Rate
Percentage of claims denied by payers.
Net Days in A/R
Average time taken to collect payment.
A/R Over 90 Days
Older receivables at risk of non-collection.
Touches per Claim
Number of actions required to resolve a claim.
Authorization & Timely Filing Denials
Claims denied due to compliance or deadline issues.
What the AI Billing Audit Delivers
- Finds coding, documentation, and medical necessity issues before claims are submitted, helping improve payment outcomes.
- Makes the billing process more efficient by flagging issues at the right stage across the revenue cycle.
- Cuts down on time-consuming, costly rework by getting claims right the first time
- Helps keep billing consistent while improving audit readiness, compliance, and alignment with payer requirements.
Who This AI Medical Billing Audit Is For
It is designed for providers, clinics, hospitals, and healthcare organizations that need proactive—not reactive—oversight of billing and compliance.
AI-Powered Medical Billing Audit by Talisman
Get earlier visibility into billing quality and compliance risks without changing your existing workflows.