Case Study
How Cooper University Health Care Leveraged eValuator™ To Drive $3.2M In Revenue Integrity Impact
$3.2M
Total impact on revenue integrity
15.9X
Total annual ROI
$2.2M
New revenue captured via audit changes
Cooper University Health Care needed improved results from their auditing program, better reporting to assess the program’s impact, and greater ROI with opportunities for long-term improvement. By adopting MDaudit’s eValuator™, the health system gained instant analysis to prioritize issues, robust reporting to confirm results, and a scalable process that delivered $3.2M in total revenue integrity impact with a 15.9X annual ROI.
“Our coders do a good job with 95% accuracy, which is what CMS recommends. However, given our size and volume of care delivery, even a little improvement in coding yields a substantial impact. Our goal was to identify ways we could effectively and efficiently improve our results.”
Maureen Trainor, Director of HIM, Cooper University Health Care
Background Summary
Academic health system looks to identify additional opportunities in revenue integrity.
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The Customer Profile
Cooper University Health Care records more than 1.6M outpatient visits and $1.5B in operating revenue annually, across 663 beds and 961 providers.
1.6M+Outpatient visits
$1.5BOperating revenue
663Beds
961Providers
Coding Audit Challenges With Lack Of Long-Term Potential
Cooper University Health Care was using an outside firm to handle pre- and post-billing coding audits. The audits lacked the insights Cooper needed to know the program was compliant and reducing revenue leakage as expected.
Cooper University Health Care was looking for:
- A technology-enabled program that delivered operational and financial improvements
- Rules-based analysis that helped prioritize cases and offered automated workflows, internal or external
- A partnership that included strong customer support to ensure long-term success of the program
Goals
- Create a process for pre- and post-billing reviews
- Prioritize cases for reviews with automated workflows
- Leverage thorough reporting on operational and financial performance
The Solution
In researching potential solutions, Cooper University Health Care sought a cloud-based platform that simplified implementation while enabling use with internal or external resources. eValuator™ met Cooper’s requirements and provided robust analytics, from reporting to dashboards, to monitor and optimize performance as needed.
- Strong onboarding and training made it easy for their entire team to use
- Instant analysis helped quantify and prioritize issues to ensure maximum impact from reviews
- Robust reporting confirmed improvements and helped justify additional staff to drive further results
The Results
Cooper audited 8,690 total cases, of which 497 carried DRG changes, capturing $2.2M in new revenue and reducing $1M in risk via audit changes — a $3.2M total impact on revenue integrity and a 15.9X total annual ROI.
8,690Total cases audited
497Cases with DRG changes
$2.2MNew revenue captured
$1MRisk reduced via audit changes
$3.2MTotal impact*
15.9XTotal annual ROI
- Additional incremental revenue capture and risk mitigation
- Clear insights into operational and financial impact of the program
- Justified addition of new FTEs to further optimize outcomes
*Total impact reflects the combined impact of new revenue capture and compliance risk mitigated.
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