THE CUSTOMER PROFILE
BACKGROUND SUMMARY
Non-profit health system looks to identify additional opportunities in revenue.
The health system has been with MDaudit Enterprise since 2018. Their revenue cycle compliance department conducts an annual auditing program, prospectively auditing all providers once a year. The program also has a built-in discovery phase- so, if after a third audit, the provider is not successful, they can move into a more robust audit in which they do a concurrent audit of areas where the findings determine what needs to be focused on. The health system utilizes MDaudit to conduct its entire annual process, as well as the concurrent aspect.
The Manager of Provider Compliance Revenue Integrity shares, “Our goal is for providers to achieve 90% accuracy on that annual audit. If they do not achieve that, then we follow up with a second audit, and, if necessary, a third audit, and we do provide education on the audit findings upon each of those audit completions.”
According to the Senior Auditor, Provider Compliance Revenue Cycle (who has been with the organization since MDaudit’s initial implementation in 2018), “One of the biggest values is how MDaudit streamlines the audits, making them look uniformed, and having them all in one location.”
The Senior Auditor, Provider Compliance Revenue Cycle uses MDaudit’s Rationale Reports as an example of a template already built into the platform. These premade templates have provided a launching pad, leveraging the program’s efforts to streamline its audit processes.
Year-over-year, the health system’s revenue cycle compliance team has successfully reduced compliance risks with multiple MDaudit workflows. Always looking toward growth, the organization worked to identify additional opportunities in revenue.
THE SOLUTION
Utilize MDaudit’s Revenue Optimizer to drive revenue opportunities
The health system has increased its use of the platform by implementing MDaudit’s Revenue Optimizer (RO), a rich data analysis toolset powered by augmented intelligence to bring speed to insights and transparency on the root cause of denials.
The Director of Revenue Cycle Compliance shares, “When we see any kind of trend within MDaudit we also look at those trends regarding what the OIG (the Office of Inspector General) is seeing and what their work plan is, that helps us build out our work plan for the following year.”
The revenue cycle compliance team contributes much of its success in reducing risk to the education they have been able to offer their providers. The Manager of Provider Compliance Revenue Integrity agrees, “We use audit findings to determine what areas the providers struggle with, and we do education sessions primarily for new providers but also allow any existing providers to join those sessions.”
The Provider Compliance Revenue Integrity Manager shares how RO helps drive collaboration with the health system’s third-party billing company – uncovering insights seen from both sides. “Revenue Optimizer allows us to make sure that we are getting that message out consistently between the billing company and us. This collaboration has allowed the coders to receive the same education and information the providers receive.”
Communication challenges around denial trends are easily remedied with RO, including the common challenge around pushback on coder education, “with RO we can show them what we are seeing and why.” Coders and auditors speak the language of data, and with RO this language is tailored to the person receiving the information. The revenue cycle compliance team looks to RO heavily, and annually for their risk assessment. “As we are going through and looking at particular issues that come up, we will look at Revenue Optimizer to see if there is a trend. From there we can have the necessary conversations.”
The health system has seen tremendous growth from MDaudit Enterprise and is learning more about it every day. The Director of Revenue Cycle Compliance shares that their favorite part of Revenue Optimizer is its ability to be tailored to the user. “The way the system is built, MDaudit can always be tailored to different customers. For our health system, anytime we have needed something modified or changed, MDaudit is there helping us figure out how to create new workflows and processes.”
OUTCOMES:
Looking to the future, the Director of Revenue Cycle Compliance says the entire organization is benefiting from the use of Revenue Optimizer. Even the health system’s Chief Compliance Officer and VP are engaging with RO reports to understand how they can drive similar success on the hospital side (HB). “We’re still learning every day about new things within MDaudit and constantly engaging with our customer representative to discover the possibilities of those new things.”
With MDaudit, the non-profit health system has achieved the following outcomes over 12 months:
