The administrative burden is difficult to manage in the DRG review claims process. With millions of patients being treated on a daily basis, the sheer number of medical records is overwhelming and can block health pans from being able to move into pre-pay DRG reviews. Consider that the vast majority of DRG reviews are still driven by manual review processes, and we have the perfect storm of rising costs, spending excess, claims errors, and exhausted claims review personnel throughout the healthcare ecosystem. Increasing findings and savings in the DRG review productivity process today is directly related to the productivity of the review staff. While provider abrasion is built into the current review process, payers are faced with their own burden in accurately administering the DRG review process within a timely manner that consistently delivers the findings needed.
The Current Landscape
The current systems of manually requesting medical records, and then waiting for those records to be submitted via email, fax, online portals, or U.S. Mail, is a time-consuming and costly way of sharing important records. The time spent in simply getting records that are then delivered as an image (PDF), is inefficient and cumbersome, making productivity difficult.
The majority of DRG reviews today are manual inspections from coders and nurses, who evaluate if treatment for patients was accurately coded and that the plan followed the necessary guidelines within the confines of the DRG. Finding pertinent data in the DRG review takes time, as well as a knowledge of internal policies, common coding errors, and an ability to handle multiple DRGs within the same visit, for the same patient.
Increasing DRG Review Productivity and Efficiency With Technology
The manual process for DRG reviews has a modern-day solution. Advent Health Partners’ CAVO® platform not only intakes and extracts data from medical records, but utilizes a proprietary search functionality that allows pertinent data to be extracted at the click of a button without requiring a cumbersome visual review of the DRG. CAVO’s technology helps find common coding errors with predefined searches, customized to your organization, improving DRG validation efficiency.
By layering CAVO and its AI functionality, more DRG reviews can be executed in a fraction of the time it takes for a manual review. CAVO with Capture and Predict provides a massive staff productivity lift by extracting and sorting the medical information needed to make an accurate decision in the DRG review; the administrative burden is greatly diminished, while findings and savings are increased.
To learn more about how CAVO streamlines and accelerates the DRG review process for health plans, visit our solutions page now.