Preventing Denials: Root Cause Analysis
The Importance of Root Cause Analysis Root cause analysis is an instrumental part of any revenue integrity program as it aims to prevent denials before they ever happen. Getting down to the root cause of the issue is an—almost—surefire way to avoid the initial denial. Knowing your organization’s specific root causes will allow for faster, […]
Black History Month: Medical Pioneers
Black History Month is a time to recognize, remember, and celebrate the contributions of African Americans to U.S. history. This year, for Black History Month, Advent Health Partners acknowledges the contributions of a handful of black medical pioneers who paved the way for all medical professionals today. We have selected four accomplished doctors and nurses […]
DRG Validation and an AI Approach to Sepsis
CAVO® DRG Predict Video Series | DRG Validation In this video series, our Principal Scientist Lance Hahn, Ph.D., and our Machine Learning Engineer, Cam Carver, discuss medical record documentation and technology, including machine learning, natural language processing, artificial intelligence, named-entity recognition, and how these technologies are used for DRG validation and how to identify sepsis […]
Sepsis Diagnosis: The Impact of Age and Comorbidities
CAVO® DRG Predict Video Series | Sepsis Diagnosis Advent Health Partners 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 between sepsis definitions result in variance in […]
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
CAVO® DRG Predict Video Series | Sepsis and DRG Validations 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 definitions result in variance in billing and […]
Solutions for Common Pain Points in the Pre-Pay DRG Review Process
Introduced in the 1980s, a DRG is a crucial component of today’s healthcare system. Most DRGs today are reviewed in a post-pay environment – providing challenges for both provider and payer alike. For the provider, the post-pay DRG review comes with considerable abrasion, often requiring service fees already collected to be returned to the payer […]
4 Ways to Prevent Disallowed Charges From Bundled Claims
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 to Prepay DRG Reviews
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 Prepay DRG Reviews occur […]
Moving DRG Into The Prepay Process: Record Exchange Challenge
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 […]