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AuditGuard — Medical Billing Compliance
CMS Data: MUE Q4-2024 · NCCI 302 pairs · PUF 2022 benchmarks Free · No Login · Browser-Only
Medical Billing Compliance Screening

Know your risk before the auditors do.

Real CMS data: 820-code MUE table, 302 NCCI pairs, PUF-derived p75/p90 benchmarks, OIG Work Plan FY2024–2025, 813 global periods, 29 LCD pairs, 30-code denial rates, RAC contractor focus areas, specialty-specific compliance checklists, and a 12-month compliance calendar. All in your browser — free, private, instant.

Full Practice Profile Audit
01
Practice Profile
02
Billing Codes
03
Billing Patterns
04
Risk Factors
05
Review & Run
About Your Practice
Used to normalise volumes per provider.
MD / DO
NP
PA
LCSW / Therapist
Resident / Fellow
CPT Codes & Monthly Volumes
Quick-fill typical codes →
CPT codes auto-validate via the NIH Clinical Tables API. NCCI conflicts and MUE daily limits are checked in real time.
Global Surgical Period Alert: Your code list includes both a procedure code with an active global period and E&M codes. Verify modifier -24 is applied to any post-operative E&M.
CPT CodeDescription (auto-fills)Monthly #ModifierSetting (POS)
E&M Distribution & Care Delivery
Distribution is compared against 2021 AMA-adjusted specialty benchmarks. Total must sum to 100%.
8%
30%
47%
15%
Total: 100%
30%
50%
20%
Total: 100%
-25 (E&M + procedure same day)
-59 (Distinct procedure)
-51 (Multiple procedures)
-50 (Bilateral procedure)
-24 (E&M during global period)
-GT / -95 (Telehealth)
-TC / -26 (Technical/Professional)
Lab (in-office)
EKG / cardiac monitoring
Imaging
Infusion / injection
DME / supplies
Wound care
Compliance History & Risk Factors
Nothing you enter leaves your browser. Each domain is capped — selecting many chips does not inflate the score proportionally.
Note cloning is the most common documentation audit failure.
High % of Level 4–5 E&M (per sliders above)
Frequent modifier -25 with same-day procedures
High same-day E&M + procedure billing
Routine waiving of patient cost-sharing
Unbundling procedures (billing components separately)
Referrals to physician-owned lab / DME
Billing for services not rendered (occasionally)
Signing off on others’ notes without personal review
CCM / TCM / RPM billing without supporting infrastructure
Home health orders without face-to-face documentation
Bilateral procedures billed as two full-rate claims
Add-on codes billed without required primary code
New EHR implemented
New billing staff or company
New provider(s) joined
Significant revenue increase (>20% YoY)
New service line added
Medicare / Medicaid contract changes
Review & Run
Domain-capped scoring, per-provider volume normalisation, 2021-adjusted E&M benchmarks, live NCCI pair detection, MUE daily-plausibility, global period conflict detection, and geographic setting adjustment.
CPT Codes to Be Audited
Normalising volumes per provider…
⚠ Educational Screening Tool — Not an Official Audit, Legal Opinion, or Compliance Determination
What this tool is
A pre-audit screening checklist that applies publicly available CMS guidelines, OIG Work Plan priorities, and specialty utilization benchmarks to identify patterns that may warrant further review. Risk bands mean “consider a professional review” — not “you are non-compliant.”
What this tool is not
Not a substitute for a privileged compliance audit. Not legal advice. Does not create attorney-client privilege. Scoring weights are not calibrated against actual RAC selection data. The exact numeric score is less meaningful than the risk band.
If you receive a High or Elevated result
Engage a healthcare compliance attorney (HCCA member) and/or a certified coder (AAPC CPC or AHIMA CCS) before taking corrective action. Do not repay overpayments without legal counsel.
Privacy & HIPAA
Do not enter any patient-identifying information (names, DOBs, MRNs, or claim-level data). This tool is designed for aggregate practice-level inputs only. All processing occurs locally in your browser — nothing is transmitted to any server.
Data coverage limitations
NCCI coverage: 302 of 230,000+ CMS quarterly pairs. MUE: 820 of ~10,000 codes. Global periods: 813 codes. LCD pairs: 29 of 1,400+ active LCDs. OIG Work Plan: FY 2024–2025 only. Full CMS NCCI table →
Data currency
CMS publishes NCCI and MUE updates quarterly (Jan, Apr, Jul, Oct). OIG Work Plan is updated throughout the fiscal year. PUF benchmarks are from the 2022 release. Verify current data at oig.hhs.gov →
AuditGuard — For educational and planning purposes only. Not a substitute for professional compliance review. CMS NCCI OIG Work Plan CMS PUF AAPC CPC HCCA