DRG Validation
DRG Validation is conducted utilizing a pre or post bill chart review. The criteria utilized for chart selection is algorithm based and supports ICD-10 coding compliance. If recommendations are made for DRG change, communication will be addressed with coders and/or designated individuals at the hospital. A summary of findings will be submitted to the Executive team at the facility reporting the number of charts reviewed, the number of recommended changes, the actual number of changes and the revenue change. DRG education will be provided if indicated.
- Pre-Bill Review
- Algorithm-Based Compliance Assessment
- Unbilled Claim Assessment
- Reporting Dashboard