Case Study
How Cooper University Health Care Leveraged eValuator™ To Drive $3.2M In Revenue Integrity Impact
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.
Background Summary
Academic health system looks to identify additional opportunities in revenue integrity.
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See how Cooper University Health Care’s HIM team drove $3.2M in revenue integrity impact with MDaudit’s eValuator™.
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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.
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.
- 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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