Increase DRG Review Productivity for Your Staff

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Administrative burden is difficult to manage in the DRG review claims process. With millions of patients being treated on a daily basis, the sheer number of medical records is overwhelming. Consider that the vast majority of DRG reviews are still driven by manual review processes, and we have the perfect storm of rising costs, spending […]

DRG Validation and an AI Approach to Sepsis

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DRG Predict Video Series | Part Three of Four | DRG Validation In part three of this four-part video series, our Principal Scientist Lance Hahn, Ph.D., and our Machine Learning Engineer, Cam Carver, discuss medical record documentation and technology, including machine learning, natural language processing, artificial intelligence, named-entity recognition, and how these technologies are used […]

Sepsis Diagnosis: The Impact of Age and Comorbidities

Sepsis Diagnosis: The Impact of Age and Comorbidities

DRG Predict Video Series | Part Two of Four | Sepsis Diagnosis 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 […]

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 | Sepsis and DRG Validations 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 […]

Solutions for Common Pain Points in the Pre-Pay DRG Review Process

Two co-workers sit side by side, pointing at a list of items on a clipboard. The two are animatedly discussing the information on the paper.

“Nothing but good comes from moving to a DRG 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 to Prepay DRG Reviews

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 Prepay DRG Reviews occur […]

Moving DRG Into The Prepay Process: Record Exchange Challenge

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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

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To effectively move inot DRG 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 DRG the prepay process, including but not limited to: Number of staff to review claims Bandwidth of staff Number of claims to […]

Healthcare Interoperability Benefit #3: Improved and Consistent Patient Healthcare

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

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 […]