National Spine and Pain Center increases weekly external audits by 20% and retains more than 90% of revenue at risk with MDaudit’s External Audit Workflow. With this new workflow, they are processing 40 patient audits in less than a day, this previously took a week with manual processes.
THE CUSTOMER PROFILE
National Spine and Pain Center (NSPC) is in 12 different states, with more than 120 locations, and 750 medical professionals. They operate from both ambulatory surgery centers (ASCs) and physician clinics. For over 30 years, NSPC has been a pioneer in the relief of chronic and acute pain through minimally invasive procedures. NSPC offers three types of specialty treatment including pain medicine, neurosurgery, orthopedic treatment, and labs.
Kelly Martinelli, Director of Compliance at NSPC leads a team of four, including two auditors, a general compliance officer, and a data analyst.
THE CHALLENGE
Before MDaudit, NSPC utilized a manual platform with no built-in processes for audit reporting or tools to support provider education.
“We were experiencing the same problems as everyone else- letters are coming in, you do not know who is getting them, you might get the letter, you might not get the letter. There is no tracking or trending, so you do not have visibility into who is auditing you, or what they are auditing you for. There was no process to notify the physicians or educate them,” says Martinelli.
Without tracking and trending what is being sent to the government, organizations are exposed to extra risk. As Martinelli shared, the Center for Medicaid and Medicare Services (CMS) may have a comprehensive error rate testing (CERT) audit on a patient, but then Recovery Audit Contractors (RAC) can come in with an audit on the same patient. “That is double dipping. Without a tracking system, you would never know you are being audited twice.”
With MDaudit, Martinelli and her team saw an opportunity for success within the platform’s ability to readily provide automation of external audits and reporting. Beyond audit reporting, communication is also enhanced between the NSPC compliance team and their board. “When the board wants to know our at-risk numbers, I can now readily supply them. Our auditors can also determine where physicians need additional support,” shares Martinelli.
THE SOLUTION
Since the pandemic, NSPC has been receiving more external audit requests. This challenge shed light not only on their need for an automated process but also on increased provider education and transparent reporting to share with internal stakeholders.
With MDaudit’s External Audit Workflow (EAW) artificial intelligence (AI) function, SmartScan.ai, NSPC audit requests are scanned in and the case numbers, dates of service, and even the internal control numbers (ICNs) are all accurately pulled in. “One of the value areas around EAW is the ability to pull and organize ICNs that are 12 digits long,” says Pinheiro.
According to the Health Care Compliance Association (HCCA) the average RAC process requires that you contact them within 15 calendar days of receiving a Demand Letter, to start the discussion. The appeals clock is not put on hold for the discussion period and will run simultaneously from the date of the Demand Letter. “EAW is worth the cost, especially with 12 different locations in different states and RAC letters going everywhere,” shares Martinelli. “Even with established addresses, there are always stragglers. With EAW we can address requests by patients, and there’s no more manual faxing, we can now upload and send with confidence.”
THE OUTCOME
With a hundred-plus patient request letters, Pinheiro would have to individually send faxes for each request and then spend additional time making sure that the faxes were received. With EAW, she can process 40 patient audits in less than a day, previously this would take up to a week with the manual process. As a result, NSPC has been able to retain 90% of at-risk revenue over 12 months. “I get joy from working a really large audit. Let’s say there is a million dollars at risk and I’m in there inputting the findings from results… I love watching the numbers shift from risk to retained. That is what’s possible with EAW,” shares Pinheiro.
ADVICE FOR OTHERS
When it comes to giving other clients advice who may be considering EAW, Martinelli says, “Implementation should be taken advantage of by the people actually using the system. Tailor it for them and their needs.” Martinelli is grateful for the attentive team at MDaudit and suggests that other clients be patient with the system’s set-up while focusing on making it work for them. She also suggests the process of entering an initial audit for the sake of understanding what configurations are best for you. “Pay special attention to the standard process for naming. After all, details are everything with audits.”
External Audit Productivity– exponential growth from Q1 ’23 – Q3 ‘23
At-risk revenue retained over 12 months
