Case Study: St. Joseph Medical Center achieves 30-day record-request responses and stronger claims audit management with SAI Global Compliance 360 Claims Auditor

St. Joseph Medical Center - Customer Case Study

St. Joseph Medical Center faced an urgent compliance challenge after receiving more than 55 record requests that represented $1.1 million in revenue at risk. To coordinate responses and handle a growing variety of audits (RACs, commercial payor and plans to expand to MIC, ZPIC, MAC and CERT), the hospital turned to SAI Global’s Compliance 360 Claims Auditor as a virtual audit coordinator.

SAI Global’s Claims Auditor provided centralized tracking, visibility into outstanding items and automated reporting, enabling St. Joseph to meet its aggressive goal of responding to record requests within 30 days (versus the 45 days allowed) and to manage all active claims audits. The solution also delivered trend analysis to refine coding and billing practices, helping the medical center address denial drivers and reduce future risk while protecting the $1.1 million in exposed revenue.

St. Joseph Medical Center

Cucharras Martin

Vice President of Revenue Enhancement