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

Pre-Pay DRG Review Process Solutions

“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

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 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 […]

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 […]

National Managed Care Payer Saves Over $2 Million in 10 Minutes

Multi-line Managed Care Enterprise Reviews FI

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 […]

Healthcare Interoperability Benefit 1: Streamlined Data Exchange Between Health Plans, Healthcare Providers, and Patients

X-ray machine

According to a study conducted by Johns Hopkins, 44% of medical error deaths were preventable. As the CMS Mandate for healthcare interoperability approaches, the requirements come not a moment too soon for an industry lacking effective data exchange capabilities. Medicine and treatments have advanced tremendously through the years, as we’ve witnessed with the rapid development […]

Why Expanding Into Outpatient IB Pre-Payment Makes Sense… and Money

Health plans are working harder than ever to avoid inaccurate claims payments upfront to minimize the cost and resources required to recover over-payments on the back end. Although pre-payment itemized bill review (IBR) is still in its infancy stages of mass adoption, it is proving to be an effective method of helping plans avoid post-payment […]