Case Study: a faith-based, non-profit healthcare organization improves billing compliance and uncovers revenue opportunities with MDaudit Enterprise

Non-Profit Hospital System Drives Improvements, Even Through Times of Increased Risk

A faith-based, non-profit healthcare organization in the western U.S. faced significant challenges in adapting its compliance workflows to rapidly changing regulations, particularly those introduced during the COVID-19 pandemic. This created new risks for billing accuracy, with heightened scrutiny from government agencies and payers leading to potential denials and payment delays. To address this, they turned to MDaudit Enterprise, their existing vendor and beta testing partner since 2015, to help structure a new monitoring program.

MDaudit provided the adaptable auditing workflows needed to conduct rapid probe audits, rebill claims, and monitor error rates in real-time. This solution allowed the organization to identify compliance risks and revenue opportunities effectively. As a result, in just the last six months, they identified $120,000 in compliance risks and $225,000 in revenue opportunities using MDaudit Enterprise. The platform also enabled them to audit over 38,000 cases and use the data to deliver targeted training to providers.