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

Advent Health Partners IB Pre-Payment

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 […]

Making the Shift to Pre-Payment of Itemized Bills

Close up of a bill

According to the Center for American Progress, payers and providers in the United States spend approximately $496 billion annually on billing and insurance-related costs (BIR). Another study by the National Academy of Medicine estimates that the U.S. spends about twice as much as is necessary on BIR costs. These high costs include claims submissions, billing, […]

Bringing The Itemized Bill Review Process In-House: 3 Key Steps

Close up of bills

Hours, days, and sometimes weeks or more can be required for a payer to review and audit a medical itemized bill (IB). From outpatient procedures to long hospital stays, there are millions of insurance claims submitted for review daily. The process is time and resource consuming, yet it is essential to the payer-provider relationship of […]

Payment Integrity DRG Validations Featuring TruCode

CAVO DRG Featured Image

Most payment integrity coders face the challenge of allocating time jumping platform-to-platform to complete their DRG validations. With the CAVO and TruCode Essentials Encoder integration, your team can easily assign and validate appropriate codes all in one platform – increasing their productivity. Watch this 2-minute video to see how!

Payment Integrity Platform Features

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See CAVO’s Payment Integrity Platform Features CAVO gives health plans the ability to streamline their payment integrity review process by allowing its users to: organize cases, instantly search them, articulate their findings, and pull in additional data from other external sources with CAVO’s open API. Watch this video to learn how your team can increase […]

Health Plan Itemized Bill Review Challenges & Solutions

Solving common IB review challenges

CHALLENGES – Health Plans SOLUTIONS – CAVO IB Reviews CHALLENGE DESCRIPTION FUNCTIONALITY RESULTS Accessing accurate data Those beginning to utilize other technologies to attempt IB data capture are experiencing limited success with accuracy. Automatically extracts information from thousands of IBs. Enables efficient QA with confidence scores and click functionality that opens the corresponding IB page. Delivers […]

Payment Integrity Record Retrieval Solutions Comparison

Comparing apples to oranges

PLAN BENEFITS RECORD RETRIEVAL FUNCTIONS INSOURCE OUTSOURCE PORTAL REQUEST TECHNOLOGY AUTOMATED TECHNOLOGY Plan sends remote retrieval requests fulfilled by provider Plan performs on-site retrieval requests Plan sends remote retrieval requests fulfilled by provider Plan performs on-site retrieval requests Technology vendor sends on-demand requests via portal CAVO Connect uses FHIR calls to extract records Automate record […]

Predefined Search Functionality

Predefined Search Featured Image

See CAVO’s Predefined Search Functionality In this 40-second video, see how your medical record review team can increase their productivity by digitally searching medical records – leveraging 100+ customizable pre-defined searches (structured similar to NLP foundations) to pinpoint DRG validation information.

4 Common Health Plan Challenges in the DRG Claims Review Process

A stack of files and folders in front of a blurred background with the Advent Health Partners logo in the corner of the image

If you’re an executive at a health plan you likely spend a fair amount of time and energy thinking about minimizing provider abrasion. But what about the challenges you face on the payer side of the equation? Health plans have long struggled with inefficiencies that compromise provider relationships and hinder business performance. To illustrate those […]