Patient Billing Procedures Audit Form
Use this form to systematically assess and document compliance with patient billing procedures.
Auditor Full Name
*
First Name
Last Name
Auditor Email Address
*
example@example.com
Date of Audit
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Facility/Department Audited
*
Patient Encounter Reference (e.g., Patient ID or Visit Number)
*
Which billing procedures were reviewed during this audit?
*
Patient registration and demographic verification
Insurance verification and eligibility check
Coding accuracy (diagnoses/procedures)
Charge entry and posting
Patient statement generation
Payment posting and reconciliation
Denials management
Refund processing
Other
Billing Compliance Audit Checklist: Please indicate compliance for each item below.
*
Rows
Compliant
Non-Compliant
Not Applicable
Accurate patient demographic entry
1
2
3
Insurance information verified before billing
4
5
6
Correct coding of procedures and diagnoses
7
8
9
All charges posted accurately
10
11
12
Patient statements issued on time
13
14
15
Payments posted to correct accounts
16
17
18
Denials addressed within required timeframe
19
20
21
Refunds processed according to policy
22
23
24
Overall Compliance Rating for Billing Procedures
*
1
2
3
4
5
Summary of Findings and Recommendations
Additional Comments or Observations
Submit Audit
Should be Empty: