Sepsis Diagnosis: The Impact of Age and Comorbidities

Sepsis Diagnosis: The Impact of Age and Comorbidities

DRG Predict Video Series | Part Two of Four In part two of this four-part video series, our Clinical Product Director, Julie Scates, BSN RN, speaks with Clinical Products Specialist Amanda Curran regarding the impacts of age and comorbidity on a sepsis diagnosis. This builds on our discussion in part one about how the differences […]

US Staffing Crisis: Nurses in High Demand

Across the US, nursing shortages are close to reaching a critical level. A McKinsey survey from May 2021 reported that 22% of the nurse respondents suggested they were considering leaving their current positions driven by factors that have developed during the pandemic. To make a bad scenario even worse, over half of these nurses are […]

Sepsis-2 vs Sepsis-3 Criteria: Their Impact on Medical Records & Claims

DRG Predict Sepsis 1 vs 2

DRG Predict Video Series | Part One of Four In this first of a four-part video series, join Advent Health Partners’ Clinical Product Director, Julie Scates, BSN RN, and our VP of Clinical, Deborah Horne, as they discuss clinical diagnostic criteria utilized for clinical DRG validations. This presentation will review how the differences between sepsis […]

Solutions for Common Pain Points in the Pre-Pay DRG Review Process

Pre-Pay DRG Review Process Solutions

“Nothing but good comes from moving DRGs into a pre-pay environment”- Kurt Erikson Introduced in the 1980s, a DRG (Diagnostic Related Group) is an important component in today’s health care system. Its purpose in categorizing hospitalization costs and determining how much to pay for a patient’s hospital stay allows health plans to pay predetermined amounts […]

4 Ways to Prevent Disallowed Charges From Bundled Claims

Prevent Disallowed Charges

For the past few years, Medicare has been testing out new ways to bundle claims. The goal of this bundled claim switch is to improve care and reduce costs. A few apparent benefits in the bundled claims model have already been tested. One is simplifying the billing process by instituting a single price for all […]

Moving DRG Into The Prepay Process: The DRG Review

The Prepay Process The DRG Review

Let’s face it: the modern-day DRG review process is laborious, cumbersome, and quite often…exhausting. Every step from requesting the record to exchange, to preparing the document to review, and then notifying the provider of downgrades or changes takes time, effort, and valuable resources. Due to the time and resources required, most DRG reviews occur in […]

Moving DRG Into The Prepay Process: Record Exchange Challenge

Moving DRG PrePay Record Exchange

So you’ve selected the DRGs that you want to review…now what? Next in the process is the record exchange. One of the biggest hurdles to moving DRG reviews into the prepay process is the actual record exchange between payer and provider. Traditionally, all too often, the amount of time required to execute the record exchange […]

3 Things to Look for in a Revenue Integrity Partner

3 Things to Look for Revenue Integrity Partner FI

A revenue integrity partner is necessary for building a broader understanding of organizational claims processes and improvement opportunities. A strategic partner can help decrease time-to-revenue and reduce administrative costs. Finding and onboarding a partner for your revenue integrity program involves both time and resources, making it important to find the right fit from the start. […]

Moving DRG Into The Prepay Process: The Importance of Claim Selection

Moving DRG Into The Prepay Process

To effectively move DRGs into the prepay process, it’s important for health plans to decide which claims they want to work and when. Workflow factors ultimately determine the ability of a plan to manage the prepay process, including but not limited to: Number of staff to review claims Bandwidth of staff Number of claims to […]

The Importance of Client Success in Your Revenue Integrity Partner

Revenue Integrity Partner Client Success

Hospitals and health systems seek partnerships that provide solutions to improve revenue integrity, and a partner that fosters client success is essential and allows you to manage your revenue cycle more effectively, creating a decreased time-to-money ratio. A sense of urgency, root cause analysis, subject matter expert, open and consistent communication, and frequent reporting are […]