St. Joseph Medical Center Case Study: Compliance 360 Claims Auditor

 

Benefits of Using the Compliance 360® Claims Auditor

 

A VIRTUAL AUDIT COORDINATON

To date, St. Joseph Medical Center has received requests for over 55 records, which equates to $1.1 million in revenue at risk of recoupment and St. Joseph cites Claims Auditor as being instrumental in helping them manage all of those claims. St. Joseph set an aggressive goal of being able to respond to record requests within 30 days even though the RACs allow 45 days and according to Martin, “Claims Auditor has enabled us to achieve our objectives of responding to record requests in 30 days or less. Having the visibility into outstanding items and approaching deadlines really gives you peace of mind; I can't imagine having to manage this process without Claims Auditor.”

 

ONE SOLUTION FOR MULTIPLE AUDIT TYPES

St. Joseph realized early on that they would have to contend with more than just RAC audits, so one of the main requirements they looked for in a solution was the flexibility to handle multiple audit types. In addition to managing RAC audits, St. Joseph is currently using Claims Auditor to manage commercial payor audits and based on the success achieve so far, their intent is to use Claims Auditor to manage the broader spectrum of claims audits including MIC, ZPIC, MAC, and CERT audits.

 

TREND ANALYSIS AND REPORTING 

The reporting capabilities in Claims Auditor are helping St. Joseph refine and improve their coding and billing practices. Denied claims can be analyzed by diagnosis, claim codes, denial reasons, physician and department, and many other claim attributes. According to Martin, “We are at the point where we are starting to get some really good data to analyze and are starting to notice trends that give us insight into areas we need to review; having this capability is really critical.”

 

Claims Auditor has enabled us to achieve our objectives of responding to record requests in 30 days or less. Having the visibility into outstanding items and approaching deadlines really gives you peace of mind and I can’t imagine having to manage this process without Claims Auditor.

Cucharras Martin

Vice President of Revenue Enhancement

 

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