OVERVIEW

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.

CHALLENGES

• First generation tech addressed inpatient claims exclusively.
• Technology needed constant in-house IT support for on-premise management.
• Outcomes of audit program were not generating desired improvements in coding and revenue integrity.

GOALS

• Restructure pre-bill program for inpatient and outpatient visits.
• Streamline case reviews, automate workflows, and generate detailed reports.
• Enhance coding quality metrics through expanded audits.
• Reduce costs and IT resources.
• Secure a minimum 8x ROI.

OUTCOMES

• Improved inpatient coding accuracy to over 90% from 80% and outpatient coding accuracy to 95% from 83%.
• Expanded pre-bill audits by 50% without extra staff.
• Removed the need for internal IT support.