Healthcare

Healthcare audits, charge to disclosure.

From the payer agreement to the receivables disclosures — every estimate tied to its source.

Acme Health · Net patient revenue
FY26 · $ in thousands
Estimate flagged
Revenue waterfall
Gross patient charges$48,200+8%
Contractual allowances($24,800)+12%
Bad debt provision($1,820)+18%
Net patient revenue$21,580+3%
Estimates summary
Contractual allowance
51.5%+1.5pp vs PY
Bad debt %
3.8%+0.6pp vs PY
Settlement reserve
$850
Waterfall parsed
Estimates summarized
Allowance drift flagged

Payer agreements run sixty pages. Contractual allowances change quarterly. And the allowance memo is due Friday.

01·The Agreement·Co-Audit

Read the payer agreements.

Ask about reimbursement methodology, settlements, terminations. Co-Audit cites the section behind each answer.

See Co-Audit
Co-Audit
United Health · payer agreement
How are contractual allowances calculated under this agreement?
Payments are based on fee schedules in Exhibit B, with quarterly true-ups against actual cost report data.
Reimbursement methodology
BaseExhibit B fee schedule
True-upQuarterly · cost report
SettlementAnnual reconciliation
uhc_provider_agmt.pdf· §4.2, page 14
Ask Co-Audit anything…
02·The Match·Match Agent

Cash to claims, in one view.

Match Agent ties the deposit through the 835 remittance back to the claim. Contractual adjustments stay visible per row.

See Match Agent
Cash deposit · 03/14/2026
Deposit total $5,048 · matched to 4 claims
Reconciled
Claim
Payer
Gross
Contr. adj.
Net
Tie
CLM-8421
UHC
$4,820
($2,410)
$2,410
CLM-8434
Aetna
$3,200
($1,920)
$1,280
CLM-8512
BCBS
$2,940
($2,100)
$840
CLM-8618
Medicare
$1,150
($632)
$518
CLM-8512 contractual adjustment exceeds fee schedule.Lock match
03·The Recalc·Test Agent

Patient revenue, tested per encounter.

Charge, contract, net revenue — tested across the sample. Allowance recalcs run against the actual fee schedule.

See Test Agent
Patient revenue testing
Charge → contract → net revenue
Testing
Encounter
CPT
Charge
Payer
Net rev
Result
ENC-4287
99213
$420
UHC
$215
Pass
ENC-4391
99214
$580
BCBS
$298
Review
ENC-4422
99203
$340
Aetna
$172
Pass
ENC-4488
99215
$720
Medicare
$398
Open
4 attributes · 1 review · 1 openWorkpaper
04·The Statements·Financial Statement Review

Receivables that hold up to review.

Patient receivable aging foots. Allowance methodology drift gets flagged on the bucket where it broke.

See Financial Statement Review
Net Patient Receivables — FY26
$ in thousands · ASC 606 / ASC 326
In review
Current30-6060-90>90Total
Gross$4,200$1,800$920$1,650$8,570
Allowance %5%12%28%65%
Allowance($210)($216)($258)($1,073)($1,757)
Net$3,990$1,584$662$577$6,813
18% increase in >90 day bucket vs PY — allowance methodology needs review.

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