Case Study: Methodist Hospital System achieves control of claims audits and minimizes revenue recoupment with SAI Global

Methodist Hospital System - Customer Case Study

The Methodist Hospital System, a large non‑profit health care network in Houston, faced mounting pressure from routine CMS audits and the new, aggressive RAC program that could automatically recoup payments if appeal deadlines were missed. Lacking a centralized tracking and workflow tool to manage MAC, PERM, CERT and impending RAC audits, Methodist selected SAI Global’s Claims Auditor (the Compliance 360 Claims Auditor) to gain control of its claims audit and denial processes.

SAI Global delivered a SaaS Claims Auditor implementation in four weeks (kickoff Feb 4, go‑live Mar 4, 2009) with pre‑built RAC templates and highly customizable automated workflows that enforce deadlines, route tasks, and generate reminders. The solution gave Methodist clear visibility into claim and audit status, reduced the risk of automatic recoupments by preventing missed deadlines, enabled more proactive rebuttals and appeals, and has been expanded to manage commercial payor audits — demonstrating faster setup and measurable process control from SAI Global’s Claims Auditor.

Methodist Hospital System

Cassandra Murphy

Transaction Management Department Manager