Case Study: AI Technology for Itemized Bill Review Optimization
A multi-state health plan engaged Advent Health Partners to increase their volume of itemized bill reviews, and by leveraging Advent’s medical review technology, CAVO®, increased their total financial value by 61% after 18 months. When the payer initially engaged with Advent, their ten full-time team members manually reviewed 7,500 claims annually. After implementing CAVO into […]
Increase IB Review Findings and Savings With CAVO®
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 […]
Increase DRG Review Productivity for Your Staff
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 […]
DRG Validation and an AI Approach to Sepsis
CAVO® DRG Predict Video Series | DRG Validation In this 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 for DRG validation and how to identify sepsis […]
Moving to Prepay DRG Reviews
Let’s face it: the modern-day DRG review process is laborious, cumbersome, and quite often…exhausting. Every step from requesting the record to exchange, to preparing the document to review, and then notifying the provider of downgrades or changes takes time, effort, and valuable resources. Due to the time and resources required, most Prepay DRG Reviews occur […]
Moving DRG Into The Prepay Process: Record Exchange Challenge
So you’ve selected the DRGs that you want to review…now what? Next in the process is the record exchange. One of the biggest hurdles to moving DRG reviews into the prepay process is the actual record exchange between payer and provider. Traditionally, all too often, the amount of time required to execute the record exchange […]
CAVO IB Predict: The Present Future of Itemized Bill Review
Estimated administrative costs in the U.S. healthcare system related to billing and insurance hit $496 billion in a 2019 report released by Centers for Medicare and Medicaid Services. Central to this cost riddled with excess is the claims process between payer and provider, including claims submissions. Wherever there’s excess, there’s an opportunity to “trim the […]
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 […]