Case Study: Prisma Health improves billing compliance with MDaudit

Prisma Health Moves to MDaudit to Drive its Risk-Based Auditing Strategy

Prisma Health, South Carolina's largest healthcare organization, faced significant challenges in its ambulatory billing compliance department following a major merger. With double the workload, less staff, and a reliance on inefficient manual spreadsheet processes, the department struggled with limited audit scope, an inability to proactively identify risk trends, and a lack of critical data access. They needed to fully automate their auditing to protect the organization and implement a more effective strategy.

The solution was MDaudit, an integrated cloud-based platform providing workflow automation, risk monitoring, and analytics. MDaudit enabled Prisma Health to adopt a data-driven, risk-based auditing strategy, allowing for continuous monitoring, custom metrics, and targeted provider education. Within just six months of implementation, MDaudit helped Prisma Health audit 5,800 cases, identifying $105,000 in compliance and revenue risk. The results included a 25% increase in E&M coding accuracy and a 14% decrease in over-coding.

Prisma Health

Tara Farmer

Ambulatory Compliance Officer