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
- The Use of Technology and Analytics is Driving Substantial Productivity Gains Resulting in Healthier Margins
- Organizations are Proactively Addressing Billing Issues by Leveraging Data and Insights from Their Historical Data
- Risk Adjustment and hierarchical condition category (HCC) audits increased exponentially as scrutiny over Medicare Advantage plans accelerate
- More than 25% of Providers, on Average, Failed Audits Across Both Professional and Hospital Care Settings
- Average Denied Amount Per Claim Increased Across Professional and Hospital Care Settings
- Payers Denied More Dollars Due to Information Needed and Medical Necessity Reasons
- Total At-risk Dollars from Payer Audits Increased 5x in 2024
- Coding-related Denials Increased by More Than 100% in 2024
- More than 50% of Coders Continue to Fail Audits Across Professional and Hospital Settings
Key Takeaways
- Invest in technology, automation, and analytics to drive operational efficiency and take a proactive approach to be steps ahead of payer behavior.
- Align cross-functional teams across billing compliance, coding, CDI, and revenue integrity to share information, be transparent, and work together towards common business goals.
- Leverage the use of real-time data to support your hypothesis, identify ‘high value’ trends, and drive corrective action.
- Train and take your people along the transformation and change management journey.
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