KLAS First Look 2022 - PwC SMART

PwC US’ SMART: Automated Prebilling Analysis of Coding to Reduce Billing Errors

The KLAS report states that, ‘Medical billing errors are alarmingly frequent and cause large financial tolls for all in healthcare. It can be resource intensive for provider organizations to address these errors on their own, but as healthcare costs rise, it is imperative to prevent and correct coding errors. PwC seeks to address the issue through SMART, a prebilling solution that helps automate coding quality and regulatory compliance.’

The report says, 'PwC has deep experience in coding and regulatory compliance. Built in 1992 and since rebuilt in a new development platform, SMART is on premises and system agnostic. All surveyed customers, both new and existing of 15+ years, are highly satisfied. This is largely attributable to PwC emphasizing automation, customization, education, comparative data, and dedicated support to help counteract system complexity. While SMART increases automation, many customers state that to achieve expected outcomes, internal personnel are still needed to actively manage SMART and its generated data.'

On customer interview details, some of the comments that stood out about PwC’s strengths included:

“SMART allows us to scrub our coded data prior to submitting it for the final bill. The system is customizable, and PwC creates flags based on new regulations. If we are tracking PSI, we can set a flag so we can get that information before it goes out for the final bill for review to make sure we assign the codes properly.”

“PwC’s support people are readily available. We can email them and get a response back. They are very supportive. If I have an idea for a flag that isn’t 100% correct, the vendor brings in their expertise and makes suggestions. They help me build customized flags.” 

“PwC is proactive because they create flags based on the newest trends. The vendor is doing quick reviews based on their other clients to see what their flag rates and to see whether there is anything we can tweak. As soon as regulatory updates come out, we have the system updated, and the vendor always has an IT person available.”

Shannon O’ Shea, Principal, PwC US said, ‘It’s difficult for our clients to review thousands of claims before they bill. SMART flags help them to pinpoint which cases need a second look, so they can save time by reviewing just those cases with opportunities to improve the coding. The technology helps clients speed their workflow and increase coding accuracy to maximize reimbursement. This is where SMART clients see the biggest impact -- the reduction in rework and denials, and in the long run, the uptick in revenue capture.’

Click here to read the report