WILLIAM AVERY | PHYSICAL THERAPY BILLING AUDIT WORKSHEET
https://www.williamaveryco.com/blog/physical-therapy-billing-audit-checklist
Reviewed October 3, 2026

Use this blank template inside your practice's approved secure workflow.
It supports an internal operational review, not a compliance certification.
Keep patient-level records in authorized systems; use internal references here.

REVIEW SCOPE
Review lead:
Review date / period:
Locations and payers included:
Question the review is intended to answer:
Counting unit (visit / claim / claim line):
Population and selection method:
Number of distinct records selected:
Exclusions and reasons:
Reviewers for clinical, coding, billing, and compliance questions:
Payer rules / contract versions used and relevant service dates:
Urgent items escalated outside the sample:

REVIEW AREAS — COMPLETE FOR EACH SELECTED RECORD
Internal record reference:
Relevant service date:
Reviewer / review date:

Use one status for each area:
Supported / Exception found / Needs evidence / Not applicable
Explain not-applicable items. Do not count missing evidence as a pass.

1. Visit-to-charge reconciliation
Evidence: completed-visit record, charges, unbilled queue.
Question: Was the actual service accounted for, with any hold explained?
Status / evidence reference / finding:

2. Eligibility and authorization
Evidence: coverage response, plan, applicable referral or approval.
Question: Did the information apply to this date, service, provider and location?
Status / evidence reference / finding:

3. Clinical documentation
Evidence: evaluation, plan, treatment note, applicable progress/certification records.
Question: Does the available record support the service billed?
Status / evidence reference / finding:

4. Codes, units and modifiers
Evidence: claim lines, actual services and time, applicable payer rules.
Question: Are the coding decisions supported by the record and relevant rules?
Status / evidence reference / finding:

5. Submission and status
Evidence: acknowledgments, payer claim ID, corrections, current response.
Question: Did the claim reach the payer, and is its disposition known?
Status / evidence reference / finding:

6. Payment and adjustments
Evidence: remittance, applicable terms, deposit and posting history.
Question: Can payment, adjustments and remaining balance be explained?
Status / evidence reference / finding:

7. Secondary and patient balances
Evidence: adjudication, other coverage, responsibility assignment, statements.
Question: Is responsibility assigned and followed up appropriately?
Status / evidence reference / finding:

8. Denials and open follow-up
Evidence: reason, response history, deadline, work record.
Question: Is there a supported next action, owner and due date?
Status / evidence reference / finding:

FINDINGS RECORD — COPY THIS SECTION FOR EACH FINDING
Finding reference / linked internal record:
Observation (what the evidence actually shows):
Expected requirement and source:
Information still needed:
Potential issue requiring qualified review:
Priority and reason:
Owner / next action / due date:
Action taken / date:
Current status:
Outcome and closure evidence:
Reviewer confirming closure / date:
Related workflow change / owner:
Follow-up sample or review date:

REVIEW SUMMARY
Records reviewed and how selected:
Records with exceptions (count each record once for this total):
Exceptions by category (a record may appear in multiple categories):
Items awaiting evidence:
Open actions / overdue actions:
Confirmed payments:
Approved adjustments:
Posting corrections:
Other amounts still under review:
Practice decisions required:
Process changes and next review:

Do not extrapolate an intentionally selected sample to the whole practice.
Separate payments, adjustments, and posting corrections. An action submitted
is not the same as an outcome confirmed. Route suspected unsupported billing
or overpayment questions through your established compliance process.

Sources and detailed instructions are linked in the accompanying guide.