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Actionable Insights for Healthcare Billing Compliance Teams

Dec 18, 2024 2 minute read

MDaudit’s 2024 Benchmark Report released key insights for billing compliance teams to navigate risks in the new year.  

Billing Compliance Insights You Need to Know 

  1. The Use of Technology and Analytics is Driving Substantial Productivity Gains Resulting in Healthier Margins 
  2. Organizations are Proactively Addressing Billing Issues by Leveraging Data and Insights from Their Historical Data 
  3. Risk Adjustment and hierarchical condition category (HCC) audits increased exponentially as scrutiny over Medicare Advantage plans accelerate 
  4. More than 25% of Providers, on Average, Failed Audits Across Both Professional and Hospital Care Settings 
  5. Average Denied Amount Per Claim Increased Across Professional and Hospital Care Settings 
  6. Payers Denied More Dollars Due to Information Needed and Medical Necessity Reasons 
  7. Total At-risk Dollars from Payer Audits Increased 5x in 2024 
  8. Coding-related Denials Increased by More Than 100% in 2024 
  9. More than 50% of Coders Continue to Fail Audits Across Professional and Hospital Settings

Key Takeaways 

  1. Invest in technology, automation, and analytics to drive operational efficiency and take a proactive approach to be steps ahead of payer behavior.  
  2. Align cross-functional teams across billing compliance, coding, CDI, and revenue integrity to share information, be transparent, and work together towards common business goals.  
  3. Leverage the use of real-time data to support your hypothesis, identify ‘high value’ trends, and drive corrective action.  
  4. Train and take your people along the transformation and change management journey.  

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Watch the full webinar recording and gain all of the actionable insights behind these key takeaways.  

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