How a Nonprofit Health System Used MDaudit to Audit $6M in Charges and 1,500+ Providers in 12 Months
With audit data scattered across disparate spreadsheets and every data request requiring a ticket to an already-stretched revenue cycle team, this multi-state health system’s compliance department needed direct, real-time access to its own audit data, and a way to finally track E&M Bell Curve outliers at the individual provider level.
Background Summary
Multi-state nonprofit gets real-time audit data and stops waiting on revenue-cycle tickets.
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See how this nonprofit health system used MDaudit to audit $6M in charges and 1,500+ providers in 12 months.
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The Customer Profile
This nonprofit health system operates as an integrated network spanning four states, encompassing physician clinics, outpatient centers, and hospitals. Its physician network compliance department is organized into three specialized teams, compliance auditors who proactively review physicians’ documentation and billing, compliance liaisons providing risk-based provider education, and compliance consultants offering in-depth audits and operational oversight.
The Solution
Provider profiles that once took up to a month to build by hand now take anyone on the team less than five minutes. Procedure utilization functionality lets the team run ad hoc analysis in real time instead of filing a data request with an already-stretched revenue cycle team.
- Procedure utilization functionality lets the team run ad hoc analysis in real time instead of filing a data request with an already-stretched revenue cycle team
- The platform ties a financial impact to providers deviating from the E&M Bell Curve, turning a years-old open question into an answerable one
- Monitoring more than 300 audited billing risks a month gives the team a comprehensive, proactive view of compliance issues
The Results
- Audited approximately $6M in gross charges and more than 1,500 providers in the first 12 months
- Found that 10% of audited providers failed their audits, triggering targeted education
- Now monitors more than 300 audited billing risks per month, with audit volume growing steadily each quarter
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