Six Common Claim Denial Causes for Hospitals

Medical Billing Reform Since 2008, the American Medical Association (AMA) has taken the lead to bring reform to the medical billing and payment system. Even amidst the COVID-19 pandemic, the AMA played a crucial role in shaping the federal response to the omnibus legislative package in December 2020. While healthcare organizations may still end up with a denial […]

Client Success Strategy [Video]

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Our team invests in a strategic partnership with our clients, focused on minimizing denials and ensuring appropriate reimbursement.  Advent’s clinical expertise, joined with revenue cycle technology, provides an unparalleled client success strategy. Our objective is to be the partner utilized to bridge current and future gaps within clinical reviews and provide detailed information and best […]

Plan Client Success – CAVO DRG Validation Client

Nurse reviewing a medical chart in a hospital.

/ PRE-PAY / DRG / Northeastern Regional Health Plan Covering 1M+ Lives Advances DRG Nurse Review Team Productivity using CAVO DRG Validation THEN → Chasing the Records Before CAVO DRG Validation, the record intake team gathers the medical records, depending upon facility, by: Utilizing third-party electronic delivery services, Obtaining encrypted disks from the facility, Accessing […]

Plan Client Success – CAVO Prepay IB Reviews

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/ PREPAY REVIEWS / ITEMIZED BILL REVIEWS / Regional Health Plan Decreases Pre-Pay Hospital Bill Review Time by 500+% Per Case Using IB Reviews THEN This regional health plan has an internal team of RNs performing hospital bill pre-pay IB reviews. Nurse reviewers previously either:  requested the itemized bill (IB) directly from the provider based on […]

Plan Client Success – CAVO Cost Containment Readmission Reviews

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/ POST-PAY / Cost Containment Readmission Reviews Unit Experiences 6:1 ROI During CAVO® Kick-Off Training THEN Client reviewers had to first locate the records associated with the case. Next, reviewers located appropriate documentation within the case (e.g., ED notes, Admission notes, H&P) to find presenting symptoms and reasons for admission. Nurses then pulled up their […]

Plan Client Success – CAVO Post-Pay DRG Validation

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/ POST-PAY / DRG / Large National Payer’s Post-Pay DRG Validation Team Achieves 300+% Productivity Increase with CAVO THEN This large national payer applies enterprise rules, edits, and analytics to all post-pay DRG claims to pinpoint “suspects” for potential overpayment, which are then reviewed by a team of RNs. Analytics were performed on claims that […]

Plan Client Success – CAVO Pre-pay DRG reviews at Regional Payer

Nurse sitting in front of computer at a desk.

/ PRE-PAY / DRG / Regional Health Plan’s Pre-Pay DRG Review Team Uses CAVO to Increase Productivity by 200% THEN RNs performed DRG validation reviews primarily from providers’ EMRs. Reviews were a page-to-page comparison (often averaging 500+ pages per case) within slow systems with cumbersome navigation. Once RNs located decision information, they created screenshots and […]

Plan Case Study – Using CAVO for Medical Necessity Reviews

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The Case Let’s see how CAVO Medical Necessity Reviews can help in the following scenario. Patient is a 50-year-old male who had a neurostimulator placed for pain control related to chronic back pain and right lower extremity numbness. He is a former police officer who was injured while on duty with nine subsequent back surgeries […]

Plan Case Study – Using CAVO for DRG Reviews

Doctors wheeling a patient in a bed into an emergency room at a hospital.

/ POSTPAY REVIEWS / DRG REVIEWS / Using CAVO for DRG Reviews Let’s see how CAVO DRG Reviews can help in the following scenario. Patient is a 35-year-old female with a history of prosthetic heart valve who presented to the Emergency Department complaining of rectal bleeding and heavy menstrual period for six days. She was […]

Outpatient Appeal Management at Northeast Health System

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The Challenges An extensive Northeast health system, consisting of 30+ hospitals and more than 7,000 beds, found it challenging to manage their outpatient appeal managements. While the business operations were largely centralized, the limited clinical resources tasked with defending denied claims were navigating multiple EMRs and systems, as well as having to write persuasive appeals […]