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 […]

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 […]

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 […]

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 […]

4 Common Health Plan Challenges in the DRG Claims Review Process

A stack of files and folders in front of a blurred background with the Advent Health Partners logo in the corner of the image

If you’re an executive at a health plan you likely spend a fair amount of time and energy thinking about minimizing provider abrasion. But what about the challenges you face on the payer side of the equation? Health plans have long struggled with inefficiencies that compromise provider relationships and hinder business performance. To illustrate those […]