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
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.
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.