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

5 Ways Healthcare Organizations Benefit from Remote Coding

Healthcare organizations require a high degree of accuracy in medical coding in order to keep their revenue cycle management systems running smoothly. From ensuring compliance with state and federal regulations, to making sure that reimbursements are paid on time and to the maximum, medical coding is the backbone of every healthcare organization’s financial health, whether it’s a small physician group or a large hospital.
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%).