OUTSOURCE TO ADVENT
Denial Prevention
Concurrent Reviews
DURING HOSPITAL STAY
Are you currently performing clinical concurrent reviews?
Advent’s concurrent reviews are first-level utilization reviews performed in real-time through EMR access for emergency department or inpatient cases. We:
- obtain pre-authorizations,
- provide support documentation,
- communicate with physicians, and
- collaborate with payers to provide patient’s progression and/or secure authorization through discharge.
The bottom line is that we work as an extension of your hospital or health system’s team to maximize clean claims and, ultimately, positively impact accurate reimbursement.
Pre-Bill Reviews
FOLLOWING PATIENT DISCHARGE
Are you performing audits – before the bill is dropped – to ensure clinical documentation supports billed services and was medically necessary?
When reviews are proactive, denials occur less often. Start with a payer, DRG, or any single day in patient stay – and check out your results with Advent.
Our pre-bill reviews are performed after the patient is discharged but not yet billed. Receive written recommendations within a 48-hour turnaround time – avoiding any billing interruptions. Plus get assistance with necessary communications that positively impact outstanding DNFBs and their timely reimbursements. And ask us about how we further document with our appeal “lites.”
MEDICAL NECESSITY
INPATIENT/OUTPATIENT
SEVERITY OF ILLNESS
What Our Clients Are Saying
“Being able to prevent some of these problems before we ever dropped the bill was really powerful. We were even closer to getting our DNFB to three days or fewer, reducing our rate of denials, and winning by getting the claim paid correctly the first time.”
Operations Executive, Large Hospital
Denial prevention benefits
DECREASE
COST-PER-CASE
COST-PER-CASE
According to CMS, two-thirds of denials on average are recoverable. However, working denials is often labor intensive and costly. We proactively provide required documentation – including medical necessity support – aligning with payer contracts that enables timely reimbursement, reducing overall costs.
REDUCE
TIME-TO-REVENUE
TIME-TO-REVENUE
With payer expertise derived from working both with and within those organizations, we efficiently navigate communications, contracts, and guidelines during concurrent and pre-bill reviews. We initially articulate claims correctly, avoiding denials and narrowing time-to-revenue.
“90% of denials are preventable.” – CMS
A clean claim is one that a health plan processes without delay plus pays at the contracted or expected DRG rate.
[Webinar On-Demand] Using pre-bill clinical reviews to improve clean claim rates
How can you prevent clinical denials with pre-bill best practices?
- Utilize payer audit targets – including frequency and type of claims – to strategically choose pre-bill reviews.
- Structure physician education to improve queries and documentation.
REPORTING ON YOUR BUSINESS
MONTHLY STATUS REPORT
Details your claim inventory status, providing a claim roll-up of the activity taken on the claims, where they currently reside in the process, and final claim resolution.
EXECUTIVE SUMMARY
Overviews metrics for designated period and may show trends not easily seen within the project. Helps escalate any issues or opportunities for both Advent and client.
ON-TREND REPORT
Case-by-case review to determine appeal opportunities. Aggregates and outlines the story of your denials plus our recommendations for addressing root causes.
STANDARD GRAPHS
Illustratively depicts claims appealed and recovery results. Specific graphs can include appealed amounts by payer and/or denial type plus closures by reasons and/or payers.
Consulting Services
Our expert, organization-specific consultations related to the lives of cases/claims deliver application of best practices, process improvements, and departmental protocols. Specific offerings include:
- Evaluating cross-functional processes across departments
- Streamlining clinical and financial workflows
- Setting and tracking KPIs
- Modeling payer contracts
Our goal is creating a collaborative partnership with both parties equally accountable, resulting in highly productive teams and realized revenue.
How one hospital utilized pre-bill reviews to decrease denial rates
Based on root cause feedback from our denial management services, Advent recommended a 12-month pre-bill review project for this 600+ bed provider. Results included:
- Average of 300 pre-bill claims reviewed monthly.
- Denial rates reduced by 1/3 of year prior.
Ready to efficiently create effective claims?
CAVO®, our proprietary medical record review technology platform, enables revenue cycle management departments of hospitals and health systems to efficiently make decisions regarding claim submissions and appeals. CAVO allows users to instantly search medical records and quickly find needed information to determine medical necessity for claims.
COMPREHENSIVE DEFENSE
We Defend Our Decisions: In the unlikely event of a denial, Advent defends our work throughout the life of the claim – at no additional cost.
