Tag: MDAudit

Aug 25
2022

MDaudit Launches Revenue Integrity Suite to Mitigate High-Impact Denial Risk and Prevent Revenue Leakage

MDaudit, the healthcare technology company that harnesses the power of analytics and its proven track record to allow the nation’s premier healthcare organizations to retain revenue and reduce risk, announced today the launch of MDaudit Revenue Integrity Suite which brings fully integrated risk capabilities and supporting workflows together on a single platform.

The only end-to-end denials analytics technology designed to pre-emptively protect against revenue leakage by identifying and resolving systemic risks based on historical data and applied insights, MDaudit Revenue Integrity Suite proactively addresses the issues that lead to costly inpatient and outpatient claim denials.

NPC Creative Services, Thursday, August 25, 2022, Press release picture

 

“Up to 80% of denial dollars can be traced back to just 20% of denied claims – denials that are rooted in systemic issues that MDaudit Revenue Integrity Suite eradicates with a unique blend of retrospective diagnostics and predictive analytics,” said Peter Butler, president and CEO, MDaudit. “This is not just another in the industry’s long line of software that does little more than highlight coding inaccuracies without identifying the cause of denials. Rather, MDaudit Revenue Integrity Suite creates a closed-loop feedback process between insights, action, and outcomes to manage high-impact denials, making it a powerful vehicle for driving improved overall revenues.

Powered by sophisticated analytics, augmented intelligence, and expertise in providing proven revenue cycle management services and solutions to the nation’s leading healthcare provider organizations, Revenue Integrity Suite is the latest offering from MDaudit that delivers industry-leading innovation to improve outcomes through actionable analytics and empower healthcare organizations to achieve unparalleled efficiency, reduce compliance risk, and retain more revenue. MDaudit technology delivers powerful workflow automation, risk monitoring, and built-in analytics and benchmarking capabilities – all in a single integrated cloud-based platform.

MDaudit Revenue Integrity Suite gleans insights from historical data and applies them proactively to address potential denials for reasons that are either medical necessity, pricing, or treatment-related, including specialty drug and durable medical equipment (DME) utilization, thereby resolving the issues that cause high-dollar hospital claims to be denied. It features a powerful analytics engine that proactively identifies financial and clinical issues with high-value services as they are seen by payers, reducing the costliest denials and payment delays, and improving revenue and days in A/R.

By identifying, prioritizing, and addressing denial risks that have the greatest financial cost, MDaudit Revenue Integrity Suite optimizes and targets internal resources for maximum impact. It also:

“In today’s macro-economic environment, healthcare organizations are necessarily hyper-focused on achieving sustainable revenue and profitability,” said MDaudit COO Ritesh Ramesh. “Their needs drive MDaudit’s continuous search for technology-enabled approaches to ensure these organizations can keep the revenue they earn with greater predictability and less risk.”

He continues: “MDaudit Revenue Integrity Suite tackles this critical problem with an innovative, data-driven, and cross-functional approach that exceeds the capabilities and ROI of the traditional solutions in this space.”

To learn more about the Revenue Integrity Suite, visit http://www.mdaudit.com/revenue-integrity-suite/.

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Feb 8
2022

Hayes External Audit Workflow Tool Streamlines Audit Management

As payers step up efforts to identify and recoup improper payments, hospitals and health systems require innovative solutions to mitigate the potential threat these reviews pose to the bottom line. To meet this need, Hayes, a leading healthcare technology provider that partners with the nation’s premier healthcare organizations to improve revenue, mitigate risk and reduce operating costs, has launched External Audit Workflow to streamline management of external audit responses.

“The volume of external audits is rising exponentially as the Centers for Medicare and Medicaid Services and other payers search for every dollar they can recover from over-coded or otherwise improperly filed claims,” said Peter Butler, president and CEO, Hayes. “To protect their hard-earned revenues and reputations, healthcare organizations need a strong first line of defense – an external audit management process that is collaborative, efficient, and comprehensive. That is Hayes’ goal with the launch of MDaudit Enterprise External Audit Workflow.”

MDaudit Enterprise External Audit Workflow simplifies and automates time-consuming and inefficient manual processes for tracking third-party audit requests, including commercial payers, Recovery Audit Contractors (RAC), Targeted Probe and Educate (TPE), and Comprehensive Error Rate Testing (CERT). Its flexible process templates and reporting tools deliver operational efficiencies and insights on potential risks and provide a consistent and repeatable audit response process.

With External Audit Workflow, hospitals and health systems gain access to tools that bring together all their external audit management activities into a secure HIPAA-compliant SaaS-based platform.

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Oct 28
2021

Hayes’ Healthcare Audit and Revenue Integrity Analysis Finds COVID-19 Claims and Bundling Errors Driving Denials

Bundling errors continue to wreak havoc on hospital bottom lines in 2021, causing 34% of inpatient charge denials with an average value of $5,300 each. That’s according to an auditing and revenue integrity report analyzing more than $100 billion worth of denials and $2.5 billion in audited claims released today by Hayes, makers of MDaudit, the industry’s leading integrated auditing, billing compliance and revenue integrity platform for the nation’s premier healthcare organizations.

“Healthcare Auditing and Revenue Integrity: 2021 Benchmarking and Trends Report” shares the findings of Hayes’ review of professional and hospital claims audited in MDaudit Enterprise during the first 10 months of 2021. Internal auditors identified a significant number of concerns in the claims they reviewed, with approximately 33% of the audits resulting in “disagree” findings. The concerns centered primarily around disagreements between procedure codes and diagnoses.

Focusing on denial trends, bundling was the top category for both inpatient and outpatient charge denials – the latter of which had an average value of $585 for each denied claim. The top reason was that the benefit had been included in a previously adjudicated service or procedure. Professional services had a first-time denial rate of 15%, led by claim submission/billing errors and carrying an average value of $283 each, while COVID-19 claims continue to attract higher denial rates from both commercial and federal payers.

“With the pandemic driving projected losses over $100 billion this year, hospitals and healthcare organizations are under intense pressure to optimize revenue flow and reduce compliance risk,” said Peter Butler, CEO, Hayes. “Gaining control over denials by focusing on both auditing and training providers and coders to improve documentation is a logical first step – particularly given that 43% of rendering providers and 27% of hospital coders fail internal audits and auditors have ‘disagree’ findings about 33% of the time. Left unaddressed, this is a huge revenue and compliance risk for organizations.”

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