Using Technology to Transform DRG Validations

Our payment integrity platform, CAVO®, exponentially increases DRG audit efficiencies by minimizing your team’s administrative burden and maximizing their coding skill sets.

Healthcare industry statistics indicate that health plans often get it wrong in DRG reimbursement, inappropriately downgrading DRGs for sepsis, acute respiratory failure, acute kidney failure, blood loss anemia, and pneumonia. In this two-minute video, we show you how CAVO® allows your team to audit common DRGs faster.

DRG Reviews: Now vs. What's Next

Now:
Manual DRG reviews

Payment integrity coders and nurses determine appropriate DRG for reimbursement by sifting through mountains of paper sent by the provider

Plans have varied processes for verifying— and confirming—the diagnosis billed aligns with treatment during hospital confinement

Next:
Search-assisted reviews

Coders and nurses use technology to pinpoint needed information and make decisions 300+% faster – prepay or postpay.

  • Prepay reviews: Improved TATs leveraging a pre-defined search library for even quicker decisions and postpay audit avoidance
  • Postpay reviews: Trend which savings are realized immediately or extrapolated in future savings

Learn How Common DRGs are Audited Faster with CAVO

advent icon brain

Acute Encephalopathy

Severity and treatment plan determined by cause.

advent icon lungs

Pneumonia

Multiple treatment plans based on origin and type.

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Sepsis

Many different criteria used to code (for Predict).

Key Functionality for DRG Validation

Predefined Searches

  • Library of 100s of available complex “and”, “or”, and “not” statements designed to efficiently pinpoint DRG validation information.
  • Customizable to incorporate payer policies.

Moving DRG Into The Prepay Process:

The DRG Review

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