Start a contract audit with one agreement, one version and a defined group of services. Gather the rate source and exceptions, check a few independent examples, then compare the relevant payment records. Use the downloadable checklist to keep the evidence and follow-up organized.
Build the document set
Identify the signed agreement, amendments, attached schedules and any incorporated materials relevant to the question. Record the entity and product scope. Do not assume a shared payer name makes all products interchangeable.
Keep document receipt dates and effective dates separately. Use a simple version register so a second reviewer can reconstruct why a specific schedule was selected.
Create an assumptions register
For each calculation, record the payment basis, reference release, locality, setting, unit convention and exception hierarchy. Mark any interpretation requiring approval. PFS reference documentation is useful when Medicare is the agreed reference, but it does not supply the commercial interpretation.
A missing schedule or unclear exception is an actionable audit finding: identify the document or decision needed before pricing the affected services.
Test before scaling
Begin with an ordinary scenario, an effective-date boundary and an exception. Use independent expected outcomes rather than asking the same formula to verify itself. Then reconcile reported allowances, responsibility allocation and payments on the same scope.
Remittance information explains adjustments; payment evidence serves a separate purpose. Preserve the source chain rather than exporting real records to a public tool.
Assign follow-up and retain the result
For each concern, record the owner, evidence needed, correct route and applicable deadline. Do not use a generic article as the authority for a filing date. Track the resolution and cash outcome separately.
The downloadable checklist covers contract identity, products, entities, dates, schedules, modifiers, carve-outs, payment terms, testing and version control. It is free and does not require a newsletter subscription.
A small audit record
Illustrative example.
| Audit item | Example finding | Next action |
|---|---|---|
| Rate clause | 110% of a specified reference | Retain source and version |
| Product mapping | One product is uncertain | Exclude from validated total |
| Control example | $100 reference → $110 | Independently review expectation |
| Reported result | $100 allowance | Investigate the $10 difference |
| Cash outcome | Not established | Do not report a recovery |
Download the printable contract audit checklist or use the test matrix workbook.
Audit shortcuts that cause confusion
- Starting with a large total before checking a control example.
- Combining different products or versions.
- Treating a missing document as a verified assumption.
- Closing the financial outcome when the task is completed.
Start with these five checks
- Define a narrow audit scope and document set.
- Write assumptions and unresolved items.
- Independently verify control calculations.
- Reconcile and group only comparable evidence.
- Assign follow-up and measure actual outcomes.
Keep reading
For editable boundary cases, generate a contract test checklist alongside the audit worksheet.
Sources
Apply the agreement and records relevant to your review. Examples explain the method; they do not determine a payment obligation.
- PFS documentation and files
- Health Care Payment and Remittance Advice
- Payment, remittance advice and EFT transactions
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