HEALTHCARE REVENUE CYCLE MANAGEMENT AUDIT CHECKLIST 2026 Created by ChecklistGuro (https://checklistguro.com) --- PATIENT ACCESS & FRONT-END OPERATIONS --- [ ] Audit Date [ ] Auditor Name [ ] Department/Clinic Location (Primary Care, Emergency Department, Specialty Clinic, Inpatient Unit) [ ] Insurance Verification Status (Active Eligibility Confirmed, Prior Authorization Obtained, Co-pay/Deductible Identified, Secondary Insurance Verified) [ ] Patient Error Rate (%) [ ] Discrepancies Found in Demographic Data [ ] Sample Verification Documentation [ ] Compliance Officer Sign-off --- MEDICAL CODING & DOCUMENTATION ACCURACY --- [ ] Coding Accuracy Rate (%) (95% or higher, 90% - 94%, 85% - 89%, Below 85%) [ ] Identified Coding Discrepancies (Upcoding, Unbundling, Incorrect Modifier Usage, Missing Documentation Support, Incomplete Clinical Notes) [ ] Physician Query Volume [ ] Audit Completion Date [ ] Corrective Action Plan (CAP) Notes [ ] Coding Audit Evidence/Samples [ ] Auditor Verification --- CLAIM SUBMISSION & CLEARINGHOUSE SCRUBBING --- [ ] Audit Date [ ] Claim Rejection Rate (%) (0-5%, 5-10%, 10-20%, >20%) [ ] Common Rejection Reason Identified (Invalid Patient Demographics, Missing/Invalid Provider NPI, Coding Inconsistency, Duplicate Claim Submission, Insurance Eligibility Mismatch) [ ] Clearinghouse Error Log Reference ID [ ] Corrective Action Plan for Recurring Denials [ ] Claim Scrubbing Report Attachment [ ] Revenue Cycle Manager Review Signature --- ACCOUNTS RECEIVABLE (A/R) & DENIALS MANAGEMENT --- [ ] Current Days in A/R [ ] Primary Denial Reason Category (Registration/Eligibility Error, Coding/Medical Necessity, Duplicate Claim, Missing Documentation, No Authorization) [ ] Denial Mitigation Actions Taken (Resubmitted Corrected Claim, Appealed with Medical Records, Contacted Payer Representative, Adjusted/Written Off) [ ] Root Cause Analysis Summary [ ] Audit Completion Date [ ] Revenue Cycle Auditor Signature --- PAYMENT POSTING & RECONCILIATION --- [ ] Audit Completion Date [ ] Payment Posting Method (ERA (Electronic Remittance Advice), Manual Entry, Paper Check) [ ] Total Amount Reconciled [ ] Discrepancies Identified (Unapplied Credits, Unidentified Deposits, Short-pays/Underpayments, Duplicate Posting) [ ] Discrepancy Resolution Notes [ ] Reconciliation Report Attachment [ ] Auditor Verification Signature --- PATIENT BILLING & COLLECTIONS --- [ ] Patient Statement Error Rate (%) [ ] Total Unresolved Patient Balances [ ] Billing Cycle Audit Date (Monthly Review, Quarterly Review, Annual Audit) [ ] Identified Billing Discrepancies (Incorrect Patient Demographics, Inaccurate Insurance Information, Unapplied Credits, Missing Co-pay/Deductible Data, Incorrect CPT/ICD Mapping) [ ] Corrective Action Plan Notes [ ] Auditor Authentication --- COMPLIANCE & REGULATORY OVERSIGHT --- [ ] Compliance Audit Scope (HIPAA Privacy & Security, CMS Coding Compliance, OIG Compliance Program, State-Specific Healthcare Regulations) [ ] Last Compliance Review Date [ ] Identified Regulatory Risks (Data Privacy Breach Risk, Improper Coding/Upcoding Risk, Incomplete Patient Consent, Credentialing Expiration) [ ] Corrective Action Plan (CAP) Details [ ] Supporting Compliance Documentation [ ] Compliance Officer Attestation --- REVENUE CYCLE PERFORMANCE METRICS (KPIS) --- [ ] Days in Accounts Receivable (A/R) [ ] Net Collection Rate (%) [ ] Clean Claim Rate (%) [ ] Denial Rate (%) [ ] Audit Period Date (Q1 2026, Q2 2026, Q3 2026, Q4 2026) [ ] Supporting Financial Report [ ] Auditor Verification --- END OF TEMPLATE --- Transform this text into a digital, automated, and trackable mobile app! Visit: https://checklistguro.com/templates/healthcare/healthcare-revenue-cycle-management-audit-checklist-2026 (Click "Install Template" to launch your digital inspection tool immediately)