Coding integrity audits today generally share one characteristic in common: the reviewed claims make up only a small percentage of those billed. But, if you are only reviewing a portion of your billed claims, what “golden needles” might you be missing in the haystack of claims?
Client Case Studies
RevID Yields Over $1M in Net Patient Revenue with 90% Adoption
Over a three-month period, a client facing challenges in manual charge reconciliation successfully implements RevID with minimal IT involvement. This resulted in a 90% adoption rate for charge reconciliation across departments and over $1M in annualized net patient revenue.
eValuator’s Evolving, AI-Driven Ruleset Yields $11.3M of Financial Impact
A proprietary Artificial Intelligence (AI) tool, which continuously analyzes encounter and audit data across all eValuator clients, enabled the creation of new rules, enhancements to existing rules, and tailored client insights. These AI-driven rules resulted in annualized financial impact of $11.3M within six weeks.
RevID Automates Charge Reconciliation & Recovers Over $7.5M in Annual Net Patient Revenue
Client reduced over 600 manual work hours annually and recouped more than $7.5 million in annual net patient revenue by transitioning from a manual charge reconciliation program to adopting RevID.
eValuator Corrects 22% of External Vendor-Coded DRGs, Resulting in $1M Financial Impact Over 90-Days
Facing challenges in hiring inpatient coding staff, the client turned to outsourced coding support. eValuator identified a high DRG change rate associated with the outsourced vendor, resulting in the capture of approximately $600,000 in revenue and averting potential overbilling of over $400,000 in the same quarter of the outsourced vendor’s implementation.
Cooper University Health Care Case Study
Cooper University Health Care needed improved results from their auditing program, better reporting (summary & detail) to assess program’s impact, and a greater ROI and opportunities for long-term improvement.
Pre-Bill Transformation Slashed Denials by 90% and Tripled Audits without Extra Staff
Client transitioned from an inefficient, sporadic retrospective coding audit on spreadsheets to a pre bill, real time coding integrity program handling larger audits without extra staff.
Saving IT Resources, Boosting Accuracy, and Enhancing Coding Integrity
Replacing old on-premise inpatient-only technology with cloud based eValuator saved IT resources and boosted auditing impact by millions while enhancing overall revenue integrity.
Transition To Pre-Bill eValuator Increases DRG Change Rate By 80% and Enhances Coding Integrity
Switching from an outdated manual coding audit program to tech-enabled pre-bill eValuator increased the average DRG change rate from 10% to 18%, boosted auditor productivity and identified coder education for improved accuracy.