Plan Client Success – CAVO DRG Validation Client

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/ PRE-PAY / DRG / Northeastern Regional Health Plan Covering 1M+ Lives Advances DRG Nurse Review Team Productivity   THEN   → Chasing the Records The record intake team gathers the medical records, depending upon facility, by: Utilizing third-party electronic delivery services, Obtaining encrypted disks from the facility, Accessing the facility’s electronic portal, or Visiting […]

Plan Client Success – CAVO Cost Containment Readmission Reviews

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/ POST-PAY /   Cost Containment Readmission Reviews Unit Experiences 6:1 ROI During CAVO® Kick-Off Training   THEN   Client reviewers had to first locate the records associated with the case. Next, reviewers located appropriate documentation within the case (e.g., ED notes, Admission notes, H&P) to find presenting symptoms and reasons for admission. Nurses then […]

Plan Client Success – CAVO Post-Pay DRG Validation

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/ POST-PAY / DRG /   Large National Payer’s Post-Pay DRG Validation Team Achieves 300+% Productivity Increase with CAVO   THEN   This large national payer applies enterprise rules, edits, and analytics to all post-pay DRG claims to pinpoint “suspects” for potential overpayment, which are then reviewed by a team of RNs. Analytics were performed […]