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  • Find More HCCs with Automated Medical Coding

    Cavo Health is the complete auto-coding tool for Risk Adjustment, Billing Audits, and Medical Research.

  • Automated Auditing of Medical Claims

    Automated Medical Coding that Improves Accuracy of Claims and Financial Performance.

    Risk Adjustment

    Auditing and Medicaid Investigations

    Medical Research

  • New Tools for Expanded Medicaid Investigations

    Automated medical coding enables new ways to fight Medicaid waste, fraud and abuse.

    Risk Adjustment

    Auditing Claims Data

    Medicaid Investigations

  • MEDICAID INVESTIGATION

    New Discoveries Found Faster.

    Robust Analytics Toolkit

    Identify Relevant Subject Quickly

    Analyze Inclusion and Exclusion Criteria

Find More HCCs with Automated Medical Coding with Improved Accuracy
Cavo Health’s precise matching engines works differently than NLP for computer-assisted review of medical records. Instead of relying on the fuzzy word associations of machine learning, Cavo Health automates exactly for certified medical coders do. Cavo Health finds the words that confirm the presence of a Risk Adjustable ICD in a medical record. Certified coders can confirm the matches in seconds. The result? More HCCs are confirmed while chart review speeds increase 10X with greater accuracy than manual coding.

NEW TECHNOLOGY THAT TRULY IMPROVES FINANCIAL PERFORMANCE.

Some of the ways Cavo Health supports improved care and raises financial performance.

Finds new HCCs.

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Finds forgotten HCCs
in historical record.

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Accurately Codes
Encounters.

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Outstanding Security of Health Records

 

Cavo Health encrypts data in motion and at rest. Moreover, Cavo Health can run behind your firewall, making security verifications that much easier. But if you would like to use the Cloud, Cavo Health runs in a Virtual Private Network (VPN) with encrypted storage and no shared servers. Think of Cavo Health running in the Cloud as a Fort Knox inside a Fort Knox.

Process Over 400 Document formats

Cavo Health honed its processing technology in the electronic discovery industry, which is known for messy data coming in a wide variety of enterprise formats. Cavo Health’s processing is feature rich in dealing with a large assortment of data problems, from embedded images of various sizes to compressed files of compressed files seven levels deep. Cavo Health has the data processing robustness to tackle the toughest processing challenges.

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Process Scanned Images with Hybrid OCR

Scanned images are challenging enough to process. But some OCR systems are fooled by “hybrid” scanned images that contain both text and images. Not Cavo Health. Processing with Cavo Health has a setting that allows the OCR engine to both capture the text and OCR the images on the same page of a chart.

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A Smart Grid that Generates Strategic Reports

Cavo Health’s Smart Grid normalizes member data coming from the coding of medical records with claims data and data coming from other repositories. Once normalized, the Smart Grid generates custom reports that can drive member care interventions and strategic business decisions.

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Risk Adjustment

Cavo Health uses over one-half million queries to find around 10,000 ICDs that map to HCCs. Each query is sufficient to confirm an ICD. As a result, with an average of 50 ways to find an ICD that confirms an HCC, Cavo Health often finds HCCs that were missed using other methods. In fact, we at Cavo Health are so confident that Cavo Health will find HCCs missed by other methods, we are willing to serve clients with a revenue-share of new HCCs found by Cavo Health during a First or Second Pass Review.
Cavo Health makes it quick and easy to confirm ICDs in medical records. Once Cavo Health has identified the ICDs in a medical record, it presents them to medical coders along with their surrounding text. Cavo Health also provides the Section where the ICD is found, the Encounter ID, date and provider, and any medicines that provide additional MEAT. The coder has everything they need to quickly confirm the presence of the HCC in the medical record. As a result, medical coders can review medical records much faster while improving their accuracy and thoroughness.

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Solution

Patient records contain enormous amounts of key information that is now buried outside of the structured data that exists in the EMRs defined fields. As a result, data in unstructured notes (such as imbedded EMR notes typed or dictated by providers) is lost to assimilation and analysis for identifying health care trends, outcomes, costs, and connections between various providers and patients. In addition, these EMRs are from different companies and are often incompatible with each other and with external systems. Cavo Health cuts across systems to reach into medical records and extracts key data based on broad search parameters. It then presents this critical information in an intuitive visual format.

Auditing Claims Data

With no human intervention, Cavo Health auto-codes medicals records with the accuracy and thoroughness. And Cavo Health scales linearly. As a result, Cavo Health can auto-code millions of medical records with amazing speed.
With this fast coding throughput, Cavo Health can audit the medical claims of providers and payers against the corresponding medical records in near real time.
Studies show that around one-third of the codes of medical records are inaccurate. This means that payers who reimburse against unaudited claims data can assume that possibly one-third of their payments are insufficiently justified. Payers accept this reality because there has been no practical alternative.
Until now. Cavo Health can auto-code medical records overnight, so that payers can immediately know whether a bill is justified by the member’s medical record. With Cavo Health’s coding accuracy, this method can help correct billing problems early in the process, speed up reconciliations, and reduce the risk of submitting incorrect data to CMS. Cavo Health provides two-way coding at its best.

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Solution

Health care systems today manage the outcomes of huge numbers of patients. Health care entities such as insurance companies and ASCs can use Cavo Health to quickly and accurately assess their covered lives for risks, trends, and key cost drivers. By using better data, better decisions can be made to both improve patient care and lower costs.

Medicaid Investigation

Most big data Medicaid investigations rely on recognizing anomalies in billing patterns. This method has achieved success, but is limited to those unscrupulous providers who are careless in their Medicaid billing.
So, in addition to this approach, Cavo Health provides an entirely new way of revealing Medicaid waste, fraud, and abuse with big data analysis. Cavo Health can identify whether the billing data is supported by the Medicaid recipients’ medical records.
Here’s how Cavo Health does it: With no human intervention, Cavo Health auto-codes medicals records with accuracy and thoroughness. And Cavo Health scales linearly with additional hardware. As a result, Cavo Health can auto-code millions of medical records with amazing speed, and compare these codes to the codes billed to Medicaid.
Cavo Health is therefore a powerful new tool for auditing Medicaid claims in large scale. Combined with the electronic discovery toolkit of Cavo eD, Cavo Health offers a new, comprehensive approach to combating Medicaid fraud.
But Cavo Health ability to help improve the effectiveness of Medicaid programs does not end there. Cavo Health can also help reduce waste and abuse. By coding the medical records of recipients, Cavo Health can reveal which recipients are receiving medicines and treatments that they shouldn’t, which recipients are not receiving the medicines and treatments that they should, and when billed amounts for treatments and prescriptions do not match the doctor’s orders.

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Solution

Cutting edge research depends on accurate information. In addition, patient enrollment in clinical studies depends on identifying patients in a given provider’s population that meet both in inclusion and exclusion criteria for the study. Cavo Health easily analyses large data sets to provide better information. Baseline data is quickly identified. Subtle trends are easily discovered. Both structured and unstructured data is easily analyzed.