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.
Blog

Using Technology To Improve Claims Management for Healthcare Payers

A recent research report by MarketsandMarkets, the global market research platform, predicted that North America would account for “the largest share of the healthcare claims management market in 2018”. Read more
Case Studies
Risk Score Optimization through CDI
Scope: A major university-based health system wanted a thorough review of their documentation to see if it was supporting the level of care they are providing to the risk adjusted patient population.
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%).