Medicare Underpayment Audit

See where Medicare may have underpaid your practice.

Check your Medicare fee-for-service lines against the CMS rules that quietly cost practices money — every finding cited to its source.

  • Free to run — no upload, no signup, no PHI required.
  • Cross-checks NCCI & MUE edits, MPPR, modifier validity, missed G2211, and PFS / CLFS / ASP rates.
  • Every potential leak shows its dollar variance and the CMS source it was checked against.
Run a free checkRun the SRA readiness check

How it works

01

Run a sample or your lines

Try the 6-line sample, or submit your own claim-line fields — no patient identifiers, no signup.

02

Checked against CMS

The allowed amount on every Medicare fee-for-service professional line is compared to the CMS fee schedule, NCCI/MUE edits, and PFS payment policy.

03

Cited findings to review

Each potential leak comes with its dollar variance and the CMS source it was checked against — yours to review, not guaranteed recovery.

What the audit checks

Three domains of CMS logic, applied to every fee-for-service professional line.

Coding edits

NCCI procedure-to-procedure pairs and MUE per-day unit limits, with modifier-bypass review.

NCCI PTPMUEMod 59

Pricing rules

PFS, CLFS, and ASP rates; multiple-procedure (MPPR) reductions; carrier-priced and non-covered status.

PFS 2026MPPRASP

Compliance & gaps

PC/TC and modifier validity, missed G2211 add-ons, invalid-code honesty flags, and data-gap partitioning.

G2211PC/TCData gaps

Findings are routed into action queues

Queue

Charge-capture leaks

CMS-cited coding & payment-policy issues worth reviewing on your lines.

Queue

Compliance risk

Overpayments, NCCI/MUE issues, invalid modifier use, and other items to review before they become audit exposure.

Queue

Documentation review

Findings that need chart support, modifier rationale, or policy confirmation before action.

Queue

Data gaps

Missing ZIP, modifier, date, or code data that prevents a clean determination.

Scope: original Medicare fee-for-service professional claim lines. Institutional, DMEPOS, OPPS facility, Medicare Advantage plan-specific variance, Medicaid, and commercial payer variance are outside this audit.

See what Medicare may owe your practice.

Run a sample in one click, or check your own Medicare claims — free, cited to CMS, no signup.

Run a free check →