Increasing Efficiency of Claims Review Teams

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In 2020, insufficient documentation accounted for 63% of all improper payments, followed by incorrect coding (16%), medical necessity (11%), and no documentation (4%), equating to a $25.74 billion loss of revenue. Knowing and having strict standards for what is required for each scenario will help your organization implement a more efficient claims review process and […]

Medical Record Review: Efficiently Obtaining Medical Records and IBs

medical record review

Solving medical record review challenges can be similar to a game of Tetris – you have to manage your resources carefully to productively complete medical records and itemized bill reviews properly. A survey we issued recently asked 450 people what method their team used to obtain medical records and itemized bills. The majority of respondents […]

Implementing Machine Learning and NLP for Review Processes

machine learning

Machine learning (ML) isn’t just an algorithm that queries information. Machine Learning learns and adapts over time through a data feedback loop. Normal queries require human intervention to capture behavior changes, whereas machine learning recognizes this and makes modifications itself. Natural language processing (NLP) looks for variants in language. For example, myocardial infarction and heart […]

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 […]

Payment Integrity DRG Validations Featuring TruCode [Video]

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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]

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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 […]

50%+ Faster DRG Claim Reviews [WEBINAR]

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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 […]