Increasing Efficiency of Claims Review Teams

Claims Review process

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 […]

Proper Reimbursement Payer Policies [Webinar]

Proper Reimbursement

When aiming to ensure proper reimbursement for your hospital or health system, many variables are involved to continually refine payer policies to individual chargemasters. In this webinar recorded in partnership with HFMA Region 9, Deborah Horne, Advent Health Partners’ Vice President of Clinical Operations, discusses the current challenges in receiving reimbursement. She walks through a case […]

DRG Validation and an AI Approach to Sepsis

DRG Predict Video Three Thumbnail

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 […]

91+% Denial Overturn Rate

denial overturn rate

How We Achieve Our 91+% Denial Overturn Rate In this 1-minute video, you will discover tips on our strategic appeal process for achieving a 91+% denial overturn rate.  With this insight and leveraging clinical and payer expertise, you could enhance your overturn rate to ensure maximum appropriate reimbursement from the payer.

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 […]

Denial Management Trends for 2021

2021 Denial Management Trends Featured Image

Denial Management Trends for 2021 While medical necessity remained the number one type of denials in 2021, our team has seen three additional denial management trends emerge as significant sources of denials. If your hospital or health system is experiencing any of these denials, know that there are answers and ways to prevent them from […]

5 Strategies to Help Interpret Denial Data

Graphs and charts on iPad with Apple pencil

5 Strategies to Help Interpret Denial Data Data and data analysis are an integral part of denial management. In some cases, denial management teams need help identifying the important information or the trends they should be looking for. The five strategies below can help teams interpret denial data and best utilize it within the denial […]