Announcement: Advent Health Partners is now TREND Health Partners. See Press Release for details.

Shifting Your DRG Reviews to Pre-Pay

Shifting Your DRG Reviews to Pre-Pay

Welcome to the future of DRG reimbursement—where the power of AI, clinical expertise, and innovative technology are combined to drive more favorable financial outcomes for health plans.

Our newest video shows you more about the benefits of working DRGs through a pre-pay system vs a post-pay one, why this industry shift is occurring now, and how your organization can utilize our AI technology, CAVO®, to help implement these new pre-pay practices efficiently and effectively.

Fill out the form on the video to gain access to our newest video, “Shifting to Pre-Pay DRG Reviews”

Pre-Pay DRG Resources

The Importance of DRG Claim Selection

To effectively transition to a Pre-Pay DRG process, it’s paramount for health plans to determine which claims they want to work on thoroughly and when. Looking for provider trends, and determining length of service are two strong first steps to establishing a prepayment DRG framework.

Combatting Pain Points Within Pre-Pay

Effective collaboration with providers and health systems on DRG payments isn’t always as easy as it seems. Having solid frameworks around claim selection, record exchange methods, and the actual review itself can help set up both payers and providers for successful payment systems. 

Experience the Benefits of Pre-Pay DRG Reviews with CAVO

streamlined medical record review process chart
The shift to pre-pay DRG reviews can seem overwhelming, but with CAVO, health plans of all sizes can leverage our AI-driven technology to improve their payment integrity efforts and maximize financial savings and recoveries.

CAVO’s AI technology offers a guided review of potential diagnosis changes, integrates seamlessly with major EHRs such as TruCode and Epic, and has achieved SOC II/Type II and HITRUST CSF certifications. 

With over one million completed case reviews, CAVO delivers technology proven to scale up your internal medical record reviews, shift more reviews to pre-pay, and increase your team’s productivity by 300 to 500%

About Advent Health Partners

Advent Health Partners was founded in 2010 as outsourced healthcare claims review vendor.  As our business grew, the Advent claims review team of registered nurses, credentialed coders, and business analysts realized that the majority of their time was spent sifting through medical record documentation, trying to find decision data instead of making decisions.

From there, our team began building solutions to increase review efficiencies and pinpoint process improvement opportunities for health plans and hospitals.

Today, we aim to share our clinical expertise, industry-leading technology, and best practices with plans, providers, and partners to accelerate appropriate reimbursement and increase review team productivity across the healthcare industry.

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