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Description
It is accurate to assert that "not all DRG vendors are equal." Although their marketing strategies may be similar, these vendors generally fall into two categories: those that cater primarily to provider hospitals and those focused on detecting overpayments for health plans and payers. Much like how attorneys often concentrate on either defense or plaintiff cases, auditing vendors tend to specialize in the distinct needs, cultures, and priorities of their respective clients. Within the realm of payer-focused vendors, a diverse array of strategies for DRG auditing and overpayment detection exists. Our service offerings also include a dedicated physician review team that generates clinical validation findings, specifically addressing cases where identified issues stem from unsubstantiated clinical diagnoses made by treating physicians, which goes beyond the capabilities of coders. Our findings consistently demonstrate that our coding compliance model yields verified savings, contributing to enhanced financial efficiency for healthcare providers. Thus, selecting the right vendor can significantly impact the financial health of both hospitals and payers alike.
Description
Inovaare stands at the forefront of health plan solutions that facilitate digital transformation within the healthcare sector, providing automation for intricate workflows related to Medicare, Medicaid, and Commercial appeals and grievances (A&G), as well as Compliance Program Effectiveness (CPE). Their versatile cloud-based modules gather real-time data from various internal and external departments, culminating in a unified compliance management system. With adherence to HIPAA regulations, the platform incorporates the latest and most effective regulatory processes, enabling health plans to address their specific business needs, maintain audit readiness, mitigate non-compliance risks, and reduce overall operational expenses. By automating labor-intensive manual compliance tasks, Inovaare’s leading Appeals & Grievances and Regulatory Compliance solutions enhance CMS reimbursements, lower compliance audit risks, and decrease operating costs. The software is adaptable, enhancing risk identification, bolstering operational efficiency, and presenting user-friendly analytics for better decision-making. This innovative approach not only streamlines processes but also empowers healthcare organizations to navigate complex regulatory landscapes with greater confidence and agility.
API Access
Has API
API Access
Has API
Integrations
Aerial
Rackspace Cloud Files
Pricing Details
No price information available.
Free Trial
Free Version
Pricing Details
No price information available.
Free Trial
Free Version
Deployment
Web-Based
On-Premises
iPhone App
iPad App
Android App
Windows
Mac
Linux
Chromebook
Deployment
Web-Based
On-Premises
iPhone App
iPad App
Android App
Windows
Mac
Linux
Chromebook
Customer Support
Business Hours
Live Rep (24/7)
Online Support
Customer Support
Business Hours
Live Rep (24/7)
Online Support
Types of Training
Training Docs
Webinars
Live Training (Online)
In Person
Types of Training
Training Docs
Webinars
Live Training (Online)
In Person
Vendor Details
Company Name
DRG Claims Management
Founded
2009
Country
United States
Website
www.drgclaims.com/solutions/
Vendor Details
Company Name
Inovaare
Founded
2006
Country
United States
Website
www.inovaare.com