Deliver a Healthy Bottom Line
Bringing proven integrated risk capabilities and workflows into a single platform, the MDaudit Revenue Integrity Suite creates a closed-loop feedback process between insights, action, and outcomes to manage high-impact denials.
The Revenue Integrity Suite automates an end-to-end denials prevention process that uniquely:
- Leverages payer remits to diagnose systemic risk based on trends
- Applies those insights to pre-payment charges to identify potential denials
- Recommends erroneous claims for proactive audit and corrections before releasing to payers
- Prevents denials
1. Rapid Diagnosis of Denial Risks
Analyzes 835 remittance data to diagnose systemic denial trends
Based on the denial risks and trends, a targeted and impactful sample of pre-payment charges are sent to MDaudit daily
Retrospective audits can be scheduled as per risks identified
2. Predictive – High Value Denials
Pre-payment (Pre-bill or non-adjudicated charges) are run through powerful payer centric rules engine
3. Call for Action
- Fix systemic issues with clinical documentation
- Fix systemic billing and coding processes
- Proactively catch and fix claims to get paid faster and
improve cash flow - Educate providers and coders
Harness the Power of Data
Proactively Reduce Denial Rates
Fully integrate remit and pre-bills claims, blending retrospective diagnostics and predictive analytics to manage and prevent denials in a way other systems cannot.
Maximize Impact
Identify, prioritize and address the systemic denial risks with the greatest financial impact, maximizing precious resources for use where they are needed most.
Correct Claims
Leverage the unique payer-centric rules engine based on a nationwide payer base to provide an additional layer of validation not offered by traditional claims scrubbers.
Act On The 20% Of Your Denials Volume That Drives 80% Of Your Denials Impact
The MDaudit Revenue Integrity Suite goes beyond the limitations of traditional claim scrubbers. While claim scrubbers are useful for highlighting coding accuracy errors, they fall short in identifying the common causes for denials of high-dollar claims related to Pharmacy/Drugs, Durable Medical Equipment (DME)/Implants, and Complex Diagnoses. These denials often occur due to medical necessity, information needed, and missing documentation issues, especially in the Outpatient & Ambulatory Surgical Center locations.
Unlike claim scrubbers, MDaudit specializes in significantly mitigating denials in these specific areas. Our approach involves leveraging historical data to identify systemic risks and proactively address potential denials. By resolving the underlying issues that traditional claim scrubbers cannot find, our Revenue Integrity Suite ensures a significant decrease in denials along with a healthy increase in cash flow.
Unique, Payer-Centric Rules Engine
Based on a nationwide payer base to provide an additional layer of validation not offered by traditional claims scrubbers, the payer-centric rules engine will identify what will deny, why it will deny, and how you can fix it. A targeted and impactful sample of pre-bill charges is flagged for review, which intercepts those likely to result in denials or delays.
Powerful Denial Analytics
Offering a 360-view of trends through visual dashboarding so that high-dollar, high-impact denials can be immediately analyzed and mitigated; get to the root cause of systemic issues that allow you to address, correct, and educate providers.
Prospective Audit Approach
This allows you to easily disseminate what’s been identified for denial, and seamlessly pass it over to internal stakeholders to be fixed and for corrective action to be taken place.
Proven Outcomes
Results from customers who have successfully implemented Revenue Integrity Suite and transformed their revenue integrity organizations.
Projected Annual Savings
$8M - $10M
A customer has a team of 37,000 employees, providers, and volunteers who deliver care across more than 400 sites. The customer leveraged our RI suite to address denials related to DME devices for cardiology from specific manufacturers that were missing clinical trial numbers and documentation for reimbursements. Their pharmacy teams are also working to address denials related to specialty drugs that have been flagged for biosimilars and orphan drug use.
Projected Annual Savings
$3M - $5M
A customer has a team of 750+ providers across 120 locations with more than a million and a half annual patient visits yearly. The customer leveraged the RI suite to address medical necessity-related denials with knee injections and spinal cord simulators-related claims in their ASC’s and Hospital OP segment from Medicare and RAC’s that were missing clinical documentation justifying treatment paths.
