Itemized Bill Reviews Module 2019-08-08T07:51:17-06:00

CAVO® PAYER SERVICE

Itemized Bill (IB) Reviews

Auto-convert hospital bills & increase review productivity 5x.

CAVO’s module for IB Reviews intakes IBs and auto-converts them into data, enabling you to:

  • Sort and filter by revenue codes, dates, and item descriptions.
  • Easily make line-by-line accept/reject decisions with customizable reason codes for each.
  • Efficiently perform quality assurance of the IB within CAVO by comparing against the original hospital bill line.
  • Utilize real-time, auto-summed totals for adjustments and charges.
  • Create reports with auto-generated headers.

Ready to begin or expand pre-pay reviews?

Overcome prompt pay law challenges with:

  • Filterable, sortable IB data – without data entry

  • Pre-defined policy searches across your IB population

Schedule 20-minute CAVO demo

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HOW CAVO FOR IB REVIEWS WORKS

AGGREGATES

The CAVO for IB Reviews module:

  • Intakes imaged itemized bills (e.g., PDFs).
  • Creates discrete data from the hospital bill.

ANSWERS

With CAVO for IB Reviews, your team:

  • Sorts and filters hospital bill information by revenue codes, dates of service, quantities, cost, and item descriptions.
  • Makes line-by-line accept/reject decisions with customizable reason codes.
  • Auto-sums totals in real-time – including line details for adjusted amounts.

ASSEMBLES

With CAVO for IB Reviews, your team:

  • Creates reports with auto-generated headers.
  • Utilizes customizable letter templates within CAVO to efficiently communicate claims decisions to providers.

What Our Clients Are Saying

“As a member of the beta group for the CAVO Service: IB Reviews initiative, I was impressed with how well the technology translated our itemized bills into usable, sortable data. I found that the technology cut my average itemized bill review time by two-thirds. As a CAVO user of more than a year, I’ve experienced the platform evolving, and I’m excited about the possibilities as CAVO Service: IB Reviews is also continually enhanced to improve efficiencies throughout the review process.”

Claims Analyst, IB Reviews Partner

Efficient quality assurance

Reviewers utilize the CAVO for IB Reviews module to choose a line within the sorted and/or filtered information on the right screen side, and then see the corresponding highlighted hospital bill line on the left side. This functionality allows for easy comparison between the OCR data and the original hospital bill.

Client Snapshot

Regional Health Plan, Pre-Pay Hospital Bill Reviews

THEN

Nurse reviewers had to request the itemized bills (IBs) directly from the provider or export from the EMR. They then reviewed the charges line-by-line and manually keyed denial reason and reported rejections to the provider.

NOW

The nurse review team replaced the manual line-by-line review process with a targeted approach based on filterable, sortable IB data. They are leveraging CAVO’s open API to import the captured IB data directly into their internal workflow—ensuring their team completes reviews within a single platform.

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BENEFITS OF USING CAVO FOR IB REVIEWS

Less Cost

  • Cost savings on incremental reviews
  • Reallocate data entry resources to higher value activities

More Reviews

  • Increase productivity of current provider bill review team
  • Dramatic decline in time per review enables increase (or implementation) of pre-pay reviews

Create Efficiencies

  • Negate the need for itemized bill transcription
  • Replace manual page-by-page review with online hospital bill search

See CAVO Service: IB Reviews in Action

Utilize the IB Reviews module’s customizable letter templates to efficiently create provider feedback letters after a hospital bill review. In this example, the contract sets the DRG outlier at $500,000.

EXAMPLE LETTER

Pre-Pay Hospital Bill Reviews

Choose to implement the IB Reviews module only for pre-pay reviews.

  • Comply with prompt pay laws
    • eliminate data entry
    • replace manual page-by-page review with sort and filter functionality
  • Minimal training required for your team
BOOK 20-MIN DEMO

Post-Pay Hospital Bill Reviews

Perform post-pay reviews with the IB Reviews module plus CAVO Payer platform.

  • Increase productivity
    • eliminate data entry
    • replace manual page-by-page review with sort and filter functionality
    • search for related medical record information within a single platform
  • Requires standard CAVO Payer training for medical record reviews plus IB Reviews module training
MORE ABOUT CAVO PAYER

Solve common hospital bill review challenges with our module

Challenge: Automating Data Entry

Solution:
Filterable IB data

Intakes IBs and captures the line items as filterable data

Challenge: Accessing Accurate Data

Solution:
Trains IBs

Trains IBs for specific providers and EMRs

Challenge: Automating Workflow

Solution:

Map Extracted IB Data

Extract IB data and map directly to systems/processes

Challenge: Finding Itemizations

Solution:
Searchable IB Data

Enables end-users to smart search IB data for instant results