Increase DRG Review Productivity for Your Staff

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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. 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 […]

DRG Validation and an AI Approach to Sepsis

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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 […]

Solutions for Common Pain Points in the Pre-Pay DRG Review Process

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“Nothing but good comes from moving to a DRG pre-pay environment”- Kurt Erikson Introduced in the 1980s, a DRG (Diagnostic Related Group) is an important component in today’s health care system. Its purpose in categorizing hospitalization costs and determining how much to pay for a patient’s hospital stay allows health plans to pay predetermined amounts […]

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

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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 […]

Moving DRG Into The Prepay Process: The Importance of Claim Selection

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To effectively move inot DRG prepay process, it’s important for health plans to decide which claims they want to work and when. Workflow factors ultimately determine the ability of a plan to manage DRG the prepay process, including but not limited to: Number of staff to review claims Bandwidth of staff Number of claims to […]

Health Plan Challenges in the DRG Claims Review Process

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Combating Common Health Plan Challenges If you’re an executive at a health plan, you likely spend a fair amount of time and energy thinking about minimizing provider abrasion, but what about the health plan challenges you face on the payer side of the equation? Health plans have long struggled with inefficiencies that compromise provider relationships […]