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 […]

IB Predict: The Present Future of Itemized Bill Review

IB Predict The Present Future of Itemized Bill Review FI

Estimated administrative costs in the U.S. healthcare system related to billing and insurance hit $496 billion in a 2019 report released by Centers for Medicare and Medicaid Services. Central to this cost riddled with excess is the claims process between payer and provider, including claims submissions. Wherever there’s excess, there’s an opportunity to “trim the […]

Healthcare Interoperability Benefit #3: Improved and Consistent Patient Healthcare

Benefits of Interoperability

In final rules issued on March 9, 2020, the CMS Mandate for healthcare interoperability requires a patient to have instant access to their medical information via a third-party application. Effective July 1, 2021, convenient patient access to personal medical records as mandated by the Patient Access Rule enables patients to directly engage their own treatment […]

Healthcare Interoperability Benefit 2: Reduced Admin Burden & Overall Healthcare Costs

Doctor reviewing patient medical records

Here at Advent, our expertise as a solution provider in the healthcare ecosystem is to convert clinical information to FHIR® standard and provide an open API that allows its exchange between payers and providers, effectuating efficiency and reduced administrative costs in the claims process. We understand the nuances of the healthcare claims review process and […]

Plan Client Success – CAVO Itemized Bill Reviews Managed Care Enterprise

Multi-line Managed Care Enterprise Reviews FI

/ ITEMIZED BILL REVIEWS / National Managed Care Payer Saves $2M+ in 10 Minutes   THE CHALLENGE   A National Multi-line Managed Care Payer that serves as a central intermediary for both government-sponsored and privately insured health care programs saved $2M+ in 10 Minutes by leveraging our CAVO® end-to-end platform. The organization was tasked with […]