Case Study: St. Joseph Medical Center Claims Auditor Case Study

As a participating healthcare provider in Medicare and Medicaid programs, St. Joseph Medical Center in Houston, TX is subject to a variety of medical claims audits from commercial payors to those prescribed by the Centers for Medicare and Medicaid Services (CMS). With the introduction of the Recovery Audit Contractor (RAC) program by CMS, St. Joseph Medical Center was facing a new, much more expansive audit risk.

St. Joseph Medical Center assembled a team comprised of members of various departments to better understand the potential impact that RAC could have on their organization.  The team determined that millions of dollars in legitimate revenue were at stake and based on this insight, St. Joseph Medical Center came to the conclusion that they were ill-equipped to manage RAC audits on their own and decided that they needed a robust software application to better help them manage RAC and other claims audits.

Read the St. Joseph Medical Center Claims Auditor Case Study to learn how they are using Compliance 360's Claims Auditor solution to manage multiple audit types, refine and improve their coding and billing practices making them less susceptible to future denials, and exceed the RAC 45 day time frame by more than two weeks.