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 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
Introduced in the 1980s, a DRG is a crucial component of today’s healthcare system. Most DRGs today are reviewed in a post-pay environment – providing challenges for both provider and payer alike. For the provider, the post-pay DRG review comes with considerable abrasion, often requiring service fees already collected to be returned to the payer […]
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
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
To effectively move into DRG prepay process, it’s important for health plans to decide which claims they want to work and when. Workflow factors that ultimately determine the ability of a plan to manage the DRG prepay process, include but are not limited to: Number of staff to review claims Bandwidth of staff Number of […]
IB Predict: The Present Future of Itemized Bill Review
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
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 […]
National Managed Care Payer Saves Over $2 Million in 10 Minutes
A National Multiline Managed Care Payer serving as a central intermediary for government-sponsored and privately insured healthcare programs needed to audit one of their larger itemized bills. The extensive audit would be a time-intensive process involving a variety of formats and long documents. To help optimize the process for speed, efficiency, and accuracy, the Managed […]