Artificial Intelligence to Support DRG Audits
Overview of DRG Reviews DRG reviews play a crucial role in ensuring accurate reimbursement for healthcare services. The two main types of DRG reviews, clinical DRG audits, and coding reviews bring different approaches to accurate reimbursement. While coding reviews focus on the accuracy of medical coding, clinical DRG audits take a broader approach by analyzing […]
NLP in Medical Record Review
Legacy Review The traditional medical record review process has long been plagued by challenges, including the obstacle of the sheer volume of medical records that need to be reviewed. Hundreds of millions of patient records are generated daily, making it a daunting task for medical professionals to review and extract relevant information manually. The review […]
Case Study: AI Technology for Itemized Bill Review Optimization
A multi-state health plan engaged Advent Health Partners to increase their volume of itemized bill reviews, and by leveraging Advent’s medical review technology, CAVO®, increased their total financial value by 61% after 18 months. When the payer initially engaged with Advent, their ten full-time team members manually reviewed 7,500 claims annually. After implementing CAVO into […]
Artificial Intelligence in DRG Review: Streamlining Reviews and Enhancing Efficiency
Artificial Intelligence has made significant advancements to payment integrity and the DRG reviews process. By leveraging AI technologies, such as natural language processing (NLP) and machine learning (ML) algorithms, healthcare organizations can streamline the review process, improve accuracy, enhance efficiency, and better manage the cost of quality care for their constituents. Building the Model: Preprocessing […]
Shifting DRGs ‘to the left’
DRGs play an important role in the healthcare landscape; their significance, challenges, and potential to enhance revenue integrity programs in an ever-evolving market are unlike other patient categorization systems. How a payer approaches DRGs can reduce administrative burdens and refine provider relationships, and when combined with pre-pay claim review tools, they can be transformative to […]
Saving Time and Reducing Cost with cNLP
The review of medical records is critical in determining whether claims are billed and reimbursed accurately, and DRGs are the primary methodology for both hospital billing and health plan reimbursement. Although the overall methodology is well constructed and documented, several challenges are associated with a DRG review due to the reliance on the unstructured medical […]
Introducing: A Superior Client Experience
The New CAVO Interface Advent Health Partners is excited to unveil the latest release of CAVO®— featuring new, powerful features to enhance the CAVO experience. These features will enable greater flexibility among users, increase the power of individual modules, and use cases facilitating the exact functions and descriptions users need to be successful. This release […]
Five Rules for Successful AI Implementation
Artificial intelligence is complex, but utilizing it within your organization to leverage its benefits doesn’t have to be. Join Advent Health Partners’ resident expert and Chief AI Officer, Dr. Robert Coop, as he explains the concept of artificial intelligence in healthcare and the five rules of AI implementation in an easily understandable way. Why does […]
2022 CAVO® Client Experience Highlights
Going into 2023, Advent Health Partners remains committed to a high-quality, responsive, in-house client experience team and backs it up with measured proof. Outsourcing can be less client-focused and lead to low client satisfaction, lost productivity, and lost revenue. With a 100% U.S.-based support team, Advent’s clients receive faster and better support since our team […]
Increase IB Review Findings and Savings With CAVO®
Line-by-line, nurses and coders meticulously review itemized bills during the IB review process in search of findings and savings. This time-consuming review requires focused attention to search through potentially hundreds of pages and thousands of line items. The volume of itemized bills generated daily throughout the healthcare system makes efficient and complete review impossible if […]