Case Study
How Bon Secours Mercy Health Used MDaudit Risk Analytics to Drive a $9M Decrease in Professional Billing Denials
Already running a mature annual audit program on MDaudit Enterprise, Bon Secours Mercy Health wanted to catch denial trends early enough to shape next year’s work plan, and to keep providers, coders, and its third-party billing partner aligned on the same data.
Background Summary
Non-profit health system uses Risk Analytics to catch denial trends early and shape the next year’s work plan.
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See how Bon Secours Mercy Health used MDaudit Risk Analytics to drive a $9M decrease in professional billing denials.
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The Customer Profile
Bon Secours Mercy Health (BSMH) spans seven states, Florida, Kentucky, Maryland, New York, Ohio, South Carolina, and Virginia, as well as five locations in Ireland. It is one of the top five largest Catholic health systems in the U.S. and the #1 largest not-for-profit private provider in Ireland.
The Solution
BSMH has run its annual provider audit program on MDaudit Enterprise since 2018, with a built-in discovery phase that escalates unsuccessful providers into a second, third, or concurrent audit. The team has since expanded into MDaudit Risk Analytics, a rich data analysis toolset powered by augmented intelligence, to bring speed to insight and transparency into the root cause of denials.
- Prebuilt Rationale Report templates gave the team a uniform, standardized audit format instead of starting from scratch
- Risk Analytics trend data feeds directly into next year’s audit work plan, aligned with the OIG’s own annual work plan
- Shared trend data keeps providers, internal coders, and the third-party billing company aligned on the same denial-prevention message
The Results
- Decreased denials associated with professional billing coding by $9M
- Increased additional revenue by 20% year over year (2022 to 2023)
- Improved E&M accuracy by 12.8% while cutting compliance risk by 18.5% and initial denials by 40%
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