Artificial Intelligence to Support DRG Audits
Overview of DRG Reviews DRG reviews play a crucial role in ensuring accurate reimbursement for healthcare services. The two main types of DRG reviews, clinical DRG audits, and coding reviews bring different approaches to accurate reimbursement. While coding reviews focus on the accuracy of medical coding, clinical DRG audits take a broader approach by analyzing […]
Native American Heritage Month 2023: Honoring a Rich Cultural Legacy
Native American History Month 2023 Native American Heritage Month is observed every November. The significance lies in its ability to educate others about the culture and history of Native Americans. It is a time to learn about their traditions, customs, and beliefs and recognize the challenges that Native Americans have faced and continue to face. […]
NLP in Medical Record Review
Legacy Review The traditional medical record review process has long been plagued by challenges, including the obstacle of the sheer volume of medical records that need to be reviewed. Hundreds of millions of patient records are generated daily, making it a daunting task for medical professionals to review and extract relevant information manually. The review […]
Artificial Intelligence in DRG Review: Streamlining Reviews and Enhancing Efficiency
Artificial Intelligence has made significant advancements to payment integrity and the DRG reviews process. By leveraging AI technologies, such as natural language processing (NLP) and machine learning (ML) algorithms, healthcare organizations can streamline the review process, improve accuracy, enhance efficiency, and better manage the cost of quality care for their constituents. Building the Model: Preprocessing […]
Shifting DRGs ‘to the left’
DRGs play an important role in the healthcare landscape; their significance, challenges, and potential to enhance revenue integrity programs in an ever-evolving market are unlike other patient categorization systems. How a payer approaches DRGs can reduce administrative burdens and refine provider relationships, and when combined with pre-pay claim review tools, they can be transformative to […]
Saving Time and Reducing Cost with cNLP
The review of medical records is critical in determining whether claims are billed and reimbursed accurately, and DRGs are the primary methodology for both hospital billing and health plan reimbursement. Although the overall methodology is well constructed and documented, several challenges are associated with a DRG review due to the reliance on the unstructured medical […]
Out of Office: Where our Employees spend their VTO
One of the benefits Advent Health Partners team members enjoy is having eight hours of paid volunteer time off per year. Taking an active part in your local community is encouraged, and we believe in providing our employees with the opportunity to make a difference. In addition to a flexible VTO policy, Advent also plans […]
Utilization Management to Increase Patient Satisfaction
What is a health system without patients, or patients without a health system? Patient satisfaction is overwhelmingly important to the growth and success of a health system, and in turn, they expect the utmost care. That doesn’t mean the system is without its complications. Utilization management is designed to increase patient satisfaction while improving a […]
Making Medical History
March 1st marks the beginning of Women’s History Month. President Jimmy Carter in 1980 declared the first official women’s history week, and seven years later, Congress expanded the celebration to last the entire month. The 2023 Women’s History Month theme is Celebrating Women Who Tell Our Stories. Advent Health Partners is telling the stories of […]
Black History Month: Diversity in Healthcare
Black History Month Black History Month is a time to celebrate black American history and culture, but it is also a time to acknowledge the inequalities that black Americans face. Achieving inclusivity and equity is ongoing, and bringing awareness to societal gaps that minorities face is essential in all parts of life. One clear place […]