Diagnosis Related Groupings (DRG) Validation

  • All Clinicians on team are certified coders.
  • For claims with incorrectly submitted DRGs, the claim is regrouped utilizing appropriate software to the proper DRG and the payer is advised accordingly.
  • Vast experience working with Acute Care Hospitals, Academic Hospitals, LTACs, HHAs, and Trauma Centers claims.
  • Expertise with different payment systems like MS-DRGs, APR-DRGs, and IR-DRGs.
Case Studies
Claims Management - Process Innovation and Technology Result in Cost Reductions
The Challenge: Prohibitive labor cost and considerably higher turnaround time due to large number of manual adjudications resulting from mismatched information between enrollment data and provider data.
Provider Data Management - Process Innovation and Technology Result in Cost Savings
The Challenge: A cost intensive update process required checking data on all provider information update forms, rather than the ones which were actually changed (typically only 40%).