Electronic Health Reporter

MDaudit, an award-winning provider of technologies and analytics tools that enable premier healthcare organizations to minimize billing risk and maximize revenues, announced today it has elevated the artificial intelligence (AI) and automation capabilities of its industry leading billing compliance and revenue integrity platform with the addition of Insights.ai and SmartScan.ai.

A Generative AI tool, Insights.ai democratizes faster insights in response to natural language questions while SmartScan.ai leverages AI to automate key aspects of the external audit workflow process to efficiently manage payer audits. The MDaudit platform is used for compliance and revenue integrity outcomes by more than 70 of the nation’s top 100 health systems with $1 billion in net patient revenue.

The MDaudit enhancements come at a time when federal and commercial payers are ratcheting up audits to identify and claw back billions in improper payments. Consider that the U.S. Department of Justice (DOJ) collected more than $1.7 billion in improper payments in fiscal year 2022. Further, the Office of the Inspector General (OIG) identified more than $200 million in expected audit recoveries and over $277 million in questioned costs in its 2023 Semi-Annual Report to Congress.

The Centers for Medicare & Medicaid Services (CMS) is also expected to claw back $4.7 billion from Medicare Advantage plans over the next decade thanks to recent adjustments to its risk adjustment data validation (RADV) program.

“AI has the potential to transform healthcare and drive sustainable outcomes, but only if we maintain a relentless focus on the human experiences and operational processes it impacts rather than amplifying the technology itself. With this principle in mind, MDaudit continues to innovate and deliver AI solutions in the compliance and revenue integrity space,” said Ritesh Ramesh, CEO of MDaudit. “With Insights.ai and SmartScan.ai, our core mission is to enable healthcare organizations to retain their hard-earned revenue and reduce compliance risks by data-driven decision making and automation.”

Insights.ai makes it fast and easy to access the deep insights needed to drive strategic decision making. Whether it’s information about at-risk facilities, providers, coders or which DRG had the highest number of denials for medical necessity in a specific timeframe, Insights.ai democratizes insights across all levels of a healthcare organization – from billing compliance auditors, revenue cycle analysts, operational leadership and to the C-suite – by responding to questions posed in natural language with precisely the insights being sought. Insights delivered are then tightly integrated with actionable workflows to drive outcomes.

Integrated into MDaudit’s External Audit Workflow module, SmartScan.ai leverages AI technology and serverless architecture to deliver intelligent functionality to automate and accelerate management of external payer audits. It allows users to upload payer request letters from multiple payers in different formats, which are then automatically processed for workflow activities. SmartScan.ai eliminates tedious manual work of reviewing hundreds of letters from payers every week, expediting the overall resolution of audits in a quicker timeframe, resulting in faster revenue retention with less resources.

“Today is a great milestone for the MDaudit platform. The introduction of Insights.ai and SmartScan.ai activate exciting AI-driven automation and analytics capabilities,” said Lee-Ann Ruf, Vice President of Product Management at MDaudit. “Innovation at MDaudit follows a unique model of working with our customers, prospects, strategic partners, and our internal teams and I would like to thank all our stakeholders for this successful launch. Many of our customers are already using our external audit workflow to retain 95% of their revenues, and this launch further accelerates that impact.”

MDaudit collaborated with industry leaders Amazon Web Services (AWS) and ThoughtSpot on these innovations.

“At AWS, we believe AI will transform virtually every customer experience, and we are thrilled to help MDaudit scale its AI capabilities to improve end user productivity, meet growing demand, and adapt to the changing healthcare landscape,” said Ben Schreiner, head of business Innovation, US SMB at AWS. “MDaudit’s new AI-driven solutions introduce time savings, improved data accuracy, and a better customer experience, helping healthcare industry customers respond to governmental audits while retaining revenue.”

“Companies that are diving headfirst into generative AI-powered analytics and providing a modern data experience to their users will realize unprecedented competitive advantages,” said Sumeet Arora, chief development officer at ThoughtSpot. “MDaudit is driving innovation in the healthcare industry with generative AI-powered analytics, and we’re thrilled to be an innovation partner in differentiating their platform with a redefined analytics experience that drives high-value impact for their team and their customers.”