How Prisma Health Used MDaudit to Increase E&M Accuracy by 25% in Just 6 Months
After merging Palmetto Health and Greenville Health System, Prisma Health’s ambulatory compliance department found itself managing double the workload with less staff, still running on spreadsheets that made it impossible to proactively spot trends or problem areas. The team needed to move from manual, backward-looking audits to a fully automated, risk-based strategy.
Background Summary
Post-merger ambulatory compliance team leaves spreadsheets for risk-based auditing.
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The Customer Profile
Prisma Health is the largest healthcare organization in South Carolina, with nearly 2,500 beds across 18 acute and specialty care hospitals and 300 outpatient sites, employing 29,500 team members across its clinically integrated inVio Health Network. Together with inVio, Prisma Health serves almost 1.5 million patients annually across a 21-county market area covering half of South Carolina.
The Solution
Since implementing MDaudit, the team continuously monitors key risk metrics and makes data-based decisions on which providers to audit, replacing a system based on how long it had been since a provider was last reviewed.
- Custom metrics, like two new admission metrics built for new split/shared E&M service regulations, let the team quickly identify which departments to audit as rules change
- Real-time, audience-tailored reporting to the CFO, department chairs, and medical group executive leaders replaced spreadsheet reports that could only be pulled quarterly
- When Prisma was deciding whether to recruit a provider back to the health system, the team pulled the supporting financial numbers on the spot, something spreadsheets never allowed
The Results
- Audited 5,800 cases in the first 6 months, covering 243 providers and $2.7M in charges
- Identified $105K in compliance and revenue risk
- Increased E&M accuracy by 25% and reduced over-coding by 14%
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