Bringing The Itemized Bill Review Process In-House: 3 Key Steps
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 [Video]
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 [Video]
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 […]
Itemized Bill Review Challenges & Solutions
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 […]
Health Plan Challenges in the DRG Claims Review Process
Combating Common Health Plan Challenges 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 health plan challenges you face on the payer side of the equation? Health plans have long struggled with inefficiencies that compromise provider relationships […]
50%+ Faster DRG Claim Reviews [WEBINAR]
WEBINAR REPLAY 50%+ Faster DRG Claim Reviews Health plan industry veterans share three best practices for getting 50%+ faster DRG claim reviews. Hear recommendations you can apply for almost immediate productivity increases. Create a scalable DRG review process by applying three principles Filter claims with the highest potential to align your team’s time Reduce cost […]
Plan Client Success – CAVO DRG Validation Client
/ PRE-PAY / DRG / Northeastern Regional Health Plan Covering 1M+ Lives Advances DRG Nurse Review Team Productivity using CAVO DRG Validation THEN → Chasing the Records Before CAVO DRG Validation, the record intake team gathers the medical records, depending upon facility, by: Utilizing third-party electronic delivery services, Obtaining encrypted disks from the facility, Accessing […]
Plan Client Success – CAVO Prepay IB Reviews
/ PREPAY REVIEWS / ITEMIZED BILL REVIEWS / Regional Health Plan Decreases Pre-Pay Hospital Bill Review Time by 500+% Per Case Using IB Reviews THEN This regional health plan has an internal team of RNs performing hospital bill pre-pay IB reviews. Nurse reviewers previously either: requested the itemized bill (IB) directly from the provider based on […]
Plan Client Success – CAVO Cost Containment Readmission Reviews
/ POST-PAY / Cost Containment Readmission Reviews Unit Experiences 6:1 ROI During CAVO® Kick-Off Training THEN Client reviewers had to first locate the records associated with the case. Next, reviewers located appropriate documentation within the case (e.g., ED notes, Admission notes, H&P) to find presenting symptoms and reasons for admission. Nurses then pulled up their […]
Plan Client Success – CAVO Post-Pay DRG Validation
/ POST-PAY / DRG / Large National Payer’s Post-Pay DRG Validation Team Achieves 300+% Productivity Increase with CAVO THEN This large national payer applies enterprise rules, edits, and analytics to all post-pay DRG claims to pinpoint “suspects” for potential overpayment, which are then reviewed by a team of RNs. Analytics were performed on claims that […]