DRG Validation is a critical component to controlling healthcare costs and ensuring proper reimbursement. For claims reimbursed by DRG, the accuracy of the ICD-10 diagnoses and ICD-10 procedure codes, may have a significant impact on the amount of reimbursement.
Our sophisticated DRG Validator will determine if the appropriate DRG was assigned by the provider, based on the diagnosis and services as submitted on the claim form. When warranted, our team of certified coding professionals will review medical chart documentation to address potential areas of concern identified by our DRG Validator to ensure that the medical records support the primary diagnosis and procedures. When billing errors are confirmed, we obtain a corrected claim or signed agreement from the Provider, acknowledging the error and their agreement to adjust their charges and provide a refund, if applicable.
DRG validation and review can lead to enormous savings, whether pre-payment or through post-payment recoveries.