CAVO for Payment Integrity Archives | Trend Health Partners

Overpayments

Identify, resolve, and prevent unnecessary spend.

✓ Data Mining & Recovery
✓ COB Identification & Recovery
✓ ESRD Audit
✓ Clinical & Coding Validation
✓ AI Labs / Payer Intelligence

Credit Balance

The intersection of payment accuracy.

✓ Credit Balance Audit + TRENDSubmit
✓ Credit Balance Management & Prevention

Underpayments

Identify, resolve, and prevent revenue leakage.

✓ Denial Management
✓ Zero-Balance Accounts Analysis
✓ AR Rundowns

Shifting to Pre-Pay Itemized Bill Reviews

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...

Why Expanding Into Outpatient IB Pre-Payment Makes Sense… and Money

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,...

Artificial Intelligence in DRG Review: Streamlining Reviews and Enhancing Efficiency

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...

Increase DRG Review Productivity for Your Staff

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 plans from being able to move into pre-pay DRG reviews....

Solutions for Common Pain Points in the Pre-Pay DRG Review Process

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...

Moving to Prepay DRG Reviews

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,...