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 […]

Why Expanding Into Outpatient IB Pre-Payment Makes Sense… and Money

Advent Health Partners IB Pre-Payment

Health plans are working harder than ever to avoid inaccurate claims payments upfront to minimize the cost and resources required to recover over-payments on the back end. Although pre-payment itemized bill review (IBR) is still in its infancy stages of mass adoption, it is proving to be an effective method of helping plans avoid post-payment […]

Making the Shift to Pre-Payment of Itemized Bills

Close up of a bill

According to the Center for American Progress, payers and providers in the United States spend approximately $496 billion annually on billing and insurance-related costs (BIR). Another study by the National Academy of Medicine estimates that the U.S. spends about twice as much as is necessary on BIR costs. These high costs include claims submissions, billing, […]