by | Apr 2, 2024 | Article, CAVO, CAVO for Payment Integrity, Health Plans & Partners, Interoperability
Payers and providers in the United States spend approximately $496 billion annually on billing and insurance-related costs (BIR). Another study by the National Academy of Medicine estimates that the U.S. spends about twice as much as is necessary on BIR costs. These...
by | Mar 26, 2024 | Article, CAVO, CAVO for Payment Integrity, Health Plans & Partners
Health plans are working harder than ever to avoid inaccurate claims payments upfront to minimize the cost and resources required to recover overpayments on the back end. Although pre-payment itemized bill review (IBR) is still in its infancy stages of mass adoption,...
by | Sep 7, 2023 | Article, CAVO, CAVO AI, CAVO for Payment Integrity
Artificial Intelligence has made significant advancements to payment integrity and the DRG reviews process. By leveraging AI technologies, such as natural language processing (NLP) and machine learning (ML) algorithms, healthcare organizations can streamline the...
by | Jun 27, 2022 | Article, CAVO, CAVO AI, CAVO for Payment Integrity, Health Plans & Partners
The 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 and can block health pans from being able to move into pre-pay DRG reviews....
by | Sep 20, 2021 | Article, CAVO, CAVO for Payment Integrity, Health Plans & Partners
Introduced in the 1980s, a DRG is a crucial component of today’s healthcare system. Most DRGs today are reviewed in a post-pay environment – providing challenges for both provider and payer alike. For the provider, the post-pay DRG review comes with...
by | Sep 2, 2021 | Article, CAVO, CAVO AI, CAVO for Payment Integrity, Health Plans & Partners
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,...
