Case Study: Boca Raton Regional Hospital achieves stronger audit oversight and increased productivity with Optum360's Audit Management

Boca Raton Regional Hospital boosts audit oversight, improves productivity, and gets results

Boca Raton Regional Hospital, a 400‑bed tertiary medical center with more than 800 physicians, was dissatisfied with its existing RAC, CMS and payer audit solution because it lacked detailed, code‑level analysis and the ability to analyze past and current claims to prevent future audits and take‑backs. The hospital selected Optum360’s Optum Audit Management, integrated with the MedicareRT Claims System, to gain deeper claim-level insight and a comprehensive audit management platform.

Optum360 implemented Optum Audit Management to provide automated workflows, deadline tracking, claim edits, and a KPI dashboard that drills down to the claim level; the solution auto‑populates payment and claim data and supports root‑cause analysis. As a result, one staff member now manages the hospital’s RAC volume (work that previously would have required 2–3 FTEs), productivity and tracking improved, and the hospital expects reduced RAC recoveries, lower staffing costs, and better protection of revenue.

Boca Raton Regional Hospital

Veronica Small

Director, Patient Financial Services