Claims Auditor Solution from Compliance 360 provides total control of medical claims audits and appeals

Aug 24 2009

Compliance 360, a leading provider of Software-as-a-Service (SaaS) solutions for enterprise governance, risk management and compliance (eGRC) announced today that the Compliance 360 Claims Auditor has been licensed for use in over 200 hospitals since it was launched just 8 months ago. The Compliance 360 Claims Auditor helps healthcare providers take control of medical claims audits and appeals, and protect their legitimate revenues from recoupment.

Healthcare providers that have selected the Compliance 360 Claims Auditor include Caris Healthcare, Fairview Health Services, IASIS Healthcare, Legacy Health System, LHC Group, The Methodist Hospital System, Nash Health Care System, Our Lady of Lourdes Memorial Hospital, Piedmont Healthcare, St. Joseph Medical Center, and St. Luke’s Health System.

“In response to requests from the healthcare provider community, we mobilized rapidly last year to design and deliver a comprehensive solution for managing the growing threat of medical claims audits and denials,” said Steve McGraw, president and CEO of Compliance 360. “Building on our deep experience in healthcare and the proven capabilities of the Compliance 360 GRC system, we’re now providing one of the industry’s leading claims audit solutions. We attribute the industry’s rapid adoption of the Compliance 360 Claims Auditor to our unique automated workflow that enables the system to serve as a ‘Virtual Audit Coordinator’, automating the assignment of responsibilities and ensuring that critical due dates are not missed. Our customers also value our broad platform and the option to expand into a comprehensive risk management solution that encompasses the Claims Auditor. We are proud to help these progressive healthcare providers and very proud of the early success that many are already achieving.”

The Compliance 360 Claims Auditor serves as the claims audit system of record for healthcare providers by providing a central point of management for a wide variety of medical claims audits and denials, including:

• Medicare Recovery Audit Contractor (RAC) audits
• Medicaid Integrity Contractor (MIC) audits
• Medicare Program Safeguard Contractor (PSC) audits
• Medicare Comprehensive Error Rate Testing (CERT) audits
• Medicaid Fraud Control Unit (MFCU) audits
• Commercial Payer Audits

“With the expert assistance of the Compliance 360 services team, our implementation of the Compliance 360 Claims Auditor was completed earlier this year, in only one month,” said Patrick Mason, Director of Transaction Management for The Methodist Hospital System. “As we’ve been awaiting the onset of RAC audits in Texas, we’ve been using the Claims Auditor to manage our MAC, PERM and CERT audits. Based on our internal preparations and our experience with the system thus far, we believe we’re well prepared to defend our legitimate revenues from the latest recovery audits including RAC. During these times when healthcare providers face more financial challenges than they ever have in the past, the Claims Auditor from Compliance 360 is helping us gain more control of our financial fate and reduce the risks of these mounting challenges.”