Billing Compliance

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Prospective vs. Retrospective Audits? Our View: You Need Both

In virtually every operation there is always the tug-of-war question: Do you want it fast or do you want it…

Decrease Denials by Introducing Prospective Audits

It is not surprising that there has been an increased focus on preventing denials. The percentage of denied claims has…

Systematic Coder Audits: A Frequently Overlooked Secret to Improving Your Revenue Integrity

With tighter operating margins and shrinking reimbursement rates, you need to ensure your organization is not leaving any revenue behind,…

5 Key Metrics to Watch to Understand If Your Audit Program Is Effective

No matter what job you have, producing measurable results is an expectation. A CEO is measured by the value of…

Why You Need More Ways to Benchmark Than Just CMS Data

Medical claims and billing data is the currency that drives your audit and compliance program. The data you are generating…

Innovating In a Crisis – Turning Challenges Into Opportunities

When I wrote this blog at the end of 2019 laying out our MDaudit Enterprise platform vision, I never had…

CommonSpirit Health’s Smooth Transition to MDaudit Enterprise

The continuing growth of regulatory compliance demands in the healthcare industry—and the heightened risk that accompanies it—is placing an enormous…

5 Ways to Use Prospective Audits to Boost Your Bottom Line

Financial health in today’s healthcare organizations is dependent on a revenue cycle that speeds claim approval and reimbursement. Amid tight…

University of Utah Health Enhances Retrospective Audits

Even before the COVID-19 pandemic dealt a significant blow to their bottom lines, hospitals, and health systems nationwide were functioning…

HCC model: Down to the Basics from Coding to Documentation

The Basics Hierarchical Condition Categories (HCC) were mandated in 1997 by the Centers for Medicare and Medicaid Services (CMS) and…

Provider Education: Comparative Billing Reports (CBR) and the MDaudit Platform

In 2020, CMS stepped up the creation and distribution of Comparative Billing Reports (CBRs). These reports are designed to be…