Line-by-line, nurses and coders meticulously review itemized bills during the IB review process in search of findings and savings. This time-consuming review requires focused attention to search through potentially hundreds of pages and thousands of line items. The volume of itemized bills generated daily throughout the healthcare system makes efficient and complete review impossible if a coding team reviews IBs manually. Manual review leads to missed findings, which in turn, results in missed savings.
Health plans also frequently set review thresholds in determining which IBs they will review, eliminating the potential of increasing findings and savings in lesser IBs. With the current state of manual IB reviews, there is not enough bandwidth for review staff to cover all potential IBs which could lead to increased savings.
By leveraging our best-in-class CAVO® IB Review and Predict solutions, IB reviews can happen in a matter of minutes, compared to manual reviews that take hours and sometimes days. With a 5x productivity lift, the CAVO platform intakes itemized bills in various formats and extracts usable data. Once the data is normalized, users can sort, filter, sum, adjust, and even bulk adjust line items deemed unnecessary or inappropriate.
With medical records coming from different providers and locations, the industry is wrought with inefficiency in formatting information. CAVO IB Review can standardize data from over 2000+ formats, allowing reviewers to collect important data in a fraction of the time usually allocated to normalize the data in a manual review.
Featured Case Study
One national multiline managed care payer utilized CAVO IB Reviews and Predict and saved more than $2 million in under 10 minutes by auditing a $10 million, 300+ page claim. Learn how by reading our latest case study now.
One Step Further With Machine Learning
Layering our Predict solution on top of CAVO IB Review, health plans can anticipate line items they are adjusting or no longer paying in the future. Additionally, health plans can communicate the changes with providers for future reference. Industry standards can also be uploaded into the system to serve as guardrails that dictate what line items populate the interface or are recognized. Predict helps to remove the inconsistencies from end-user considerations around the coding, potential errors, plan policy, and industry guidelines.
The intake and standardization of data via IB Predict generates a consistent output for review, increasing findings and savings. Additionally, because of the productivity lift, and ability to review more IBs faster, review thresholds can also be lowered, allowing for more IB reviews to be completed in the same amount of time.
With CAVO, the opportunity for more findings and savings is around every corner and within every medical record. Get in touch to learn how CAVO can help your organization.