by | Jun 2, 2022 | Article, CAVO, Health Plans & Partners, Payer Video, Video
Solving medical record review challenges can be similar to a game of Tetris – you have to manage your resources carefully to productively complete medical records and itemized bill reviews properly. A survey we issued recently asked 450 people what method their...
by | May 25, 2022 | Article, CAVO, Health Plans & Partners, Payer Video, Payer Webinar Replay, Video
Machine learning (ML) isn’t just an algorithm that queries information. Machine Learning learns and adapts over time through a data feedback loop. Normal queries require human intervention to capture behavior changes, whereas machine learning recognizes this and makes...
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,...
by | Aug 30, 2021 | Article, CAVO, CAVO AI, CAVO for Payment Integrity, Health Plans & Partners
So you’ve selected the DRGs that you want to review…now what? Next in the process is the record exchange. One of the biggest hurdles to moving DRG reviews into the prepay process is the actual record exchange between payer and provider. Traditionally, all too often,...
by | Aug 23, 2021 | Article, CAVO, CAVO for Payment Integrity, Health Plans & Partners
To effectively move into DRG prepay process, it’s crucial for health plans to decide which claims they want to work and when. Workflow factors that ultimately determine the ability of a plan to manage the DRG prepay process, include but are not limited to: Number of...
