MDaudit Implementation Results in Tremendous Auditing Productivity and a 99.9% Coding Accuracy Rate for DHR Health
THE CUSTOMER PROFILE
DHR Health is located in Edinburg Texas. They are a rapidly growing, premier for-profit, physician-owned health system with multiple locations across Texas’s Southern border. DHR Health is nationally recognized as a best-practice model minority-serving hospital.
THE CHALLENGE
DHR Health’s challenges included manual processes, low audit volumes (PB and HB), obstacles in establishing a culture of compliance, and staying current on guidelines and regulations. Upskilling providers effectively was a long-term goal but unattainable due to a lack of resources.
While the health system’s Corporate Compliance Team experienced tremendous growth from two to seven team members- DHR Health’s landscape before MDaudit struggled with low audit volume (PB and HB) due to manual processes. On the hospital side, their DRG validation audits ran around 100 encounters a month, pre-bill.
Mayra Mendez, Compliance and Privacy Coding Audit Manager at DHR Health shares, “We had always conducted coding audits manually. It was a one-person job that I owned.” Despite working with an external audit company, DHR Health’s audit volume remained low with their manual processes.
A pioneer for the professional side, Claribel Alvarado, Compliance and Privacy Analyst shares her experience before MDaudit. “One of the major challenges was converting our manual process to an electronic process.” On the professional side, DHR has over 80+ clinics and over 250+ physicians.
The Corporate Compliance Team’s preliminary audits also identified the need for physician education and outreach. An area that caused some concern given the health system’s structure. As a physician-owned health system, the presently conservative structure felt unprepared for the challenges associated with change management. Mendez and Alvarado worried about the culture shock around the implementation of electronic processes replacing their manual ones. As well as the response to more targeted provider education.
THE SOLUTION
MDaudit’s billing and compliance solution delivered automation, improving DHR Health’s retrospective and prospective auditing productivity. Additionally, the platform provided insights to support provider education.
Backed by MDaudit data, the DHR Health compliance team was equipped with the information necessary to support implementation. Auditing reports were presented up the chain of command from the VP of Compliance to the DHR Health Board. These resources paved the way for DHR leadership to support implementation measures.
Additionally, MDaudit’s Benchmark Data allowed leadership to see how DHR Health and its providers compared nationally to other facilities and providers in the same specialty. “MDaudit’s platform, and real-time, evidence-based data reports supplied us with evidence to present to our physicians and executive teams. This really brought an awareness across the hospital of the Corporate Compliance Team’s efforts,” shares Alvarado.
Following the distribution of MDaudit reports, Alvarado and Mendez identified key stakeholders within the organization supporting direct compliance workflows. These leadership members were presented with proposals for new processes around implementation. Although this was met with initial pushback, the reinforcement of MDaudit’s industry and benchmark data prevailed and buy-in was achieved.
Solutions were still required around provider education efforts, however. Rather than using the term, “provider education” Mendez and Alvarado re-strategized their educational approach by calling their efforts “resource and guidance.” This pivot along with tailored reporting drove accuracy rate improvement substantially, with providers becoming more receptive to educational guidance. Mendez shares, “Our entire implementation approach focused on being strategic, and collaborative.”
THE OUTCOME
DHR Health has electronically converted its compliance processes and is on their way to using different scopes of audits to audit their 600+ providers, every 90 days. With the anticipated growth of the health system, DHR Health now has a solid foundation to build from.
With MDaudit, DHR Health was able to achieve the following results within 6-12 months of implementation:
- Provider accuracy improved by 22%
- HB DRG audits expanded from 100 to 800 encounters per month, with a special focus on high-dollar accounts
- Accuracy rates improved from 78% to nearly 100% of physicians being at 95% accuracy
- 900% increase in monthly retrospective audits
- 200% increase in monthly prospective audits
- 99.9% coding accuracy
