Reduce Payer Audit Risk Before Revenue Is Clawed Back
We help behavioral health practices identify billing patterns that trigger audits — using analytics and legal review.
The Problem
Payer audits aren’t random.
Behavioral health practices are increasingly audited for modifier usage, time‑based services, and provider billing patterns. Most practices only discover risk after payments are recouped.
- Surprise audits and clawbacks
- Inconsistent provider billing patterns
- No visibility into audit exposure
- Reliance on billing reports that don’t flag risk
About Arc Metrics and Consulting
What We Do
Who It’s For / Who It’s Not
How It Works
We don’t do billing.
We don’t wait for audits.
We make audit risk visible.
We do:
- Claims‑level analytics
- Provider outlier detection
- Modifier & units‑per‑visit monitoring
- Legal framing for defensibility
How It Works
Who It’s For / Who It’s Not
How It Works
Step 1 – Risk Scan
We analyze recent claims data to identify where audit exposure lives.
Step 2 – Monitoring
Monthly dashboards track changes in provider behavior, modifiers, and payer risk.
Step 3 – Audit Readiness
If an audit occurs, you already know the story your data tells.
Who It’s For / Who It’s Not
Who It’s For / Who It’s Not
Who It’s For / Who It’s Not
Good fit
- Behavioral health practices
- 5 –100 providers
- History of audits, denials, or clawbacks
Not a fit
- Solo providers
- Practices looking for billing services
- One‑time coding audits only