Physician-Led DRG Validation

Led by Clinical Expertise, Powered by Data Integration

Efficiently optimizing healthcare mid-revenue cycle performance and compliance is of paramount importance, as it enhances hospitals’ financial viability and sustainability, and also fosters a thriving healthcare ecosystem that ensures increased revenue, improved patient care and overall organizational success.

    Physician-led DRG Solution

    • We synergize expertise from our industry-leading physician advisors in CDI and coding, alongside valuable insights derived from our data integration, to accurately and compliantly capture earned revenue
      for our hospital partners.
    • Our intelligent data integration platform connects securely with hospital systems, facilitating a seamless and efficient review process that minimizes the impact on bill hold times.
    • We utilize dynamic reporting tools and dashboards to track, trend and report review outcomes.
    • With expert oversight and analysis by our physician advisors, our DRG solution reduces revenue cycle leakage to help hospitals maintain their operating margins.

    Ensuring Accurate Coding and Optimal Reimbursement

    Diagnosis-Related Group (DRG) coding validation is a crucial process that ensures accurate reimbursement and reflects the true acuity and complexity of patient populations. DRG validation involves a comprehensive review of clinical documentation and coding to determine the appropriate assignment of DRGs. This validation process verifies that the recorded diagnoses and procedures align with the patient’s medical record and meet the required criteria set forth by coding guidelines and review organizations.

    At Brundage Group, we understand the significance of DRG validation in maintaining revenue integrity while delivering high-quality care. Our physician-led DRG validation services and expertise in analytics and advisory solutions ensure accurate coding and optimal reimbursement for our hospital clients.

    Guidelines and Review Criteria

    Central to our approach is adherence to coding guidelines and review criteria established by industry authorities. Our experienced physician advisors, certified coders, and clinical documentation specialists work diligently to ensure compliance and accuracy in the DRG validation process.

    During DRG validation, our team examines the medical records, evaluating the completeness, specificity, and accuracy of documented diagnoses and procedures. We meticulously follow established guidelines, such as those provided by the Centers for Medicare and Medicaid Services, to assess whether the recorded information accurately reflects the severity and complexity of the patient’s condition. By aligning coding with the patient’s clinical reality, we ensure that your hospital’s reimbursement appropriately reflects the resources and care provided.

    Our experienced physician advisors bring their in-depth clinical expertise to the table, enabling them to identify clinical nuances that may impact coding and DRG assignments. By incorporating this knowledge, we ensure that the recorded diagnoses and procedures accurately capture the complexity and acuity of the patient population, leading to fair and optimal reimbursement.

    Uncovering Opportunities for Improvement

    DRG validation is not only about accurate reimbursement but also about identifying areas for improvement. Our comprehensive approach at Brundage Group uncovers opportunities to enhance documentation practices and coding accuracy. Through meticulous analysis of medical records, we identify coding discrepancies, documentation gaps, and potential compliance risks.

    Our team’s keen eye for detail lets us recognize trends and patterns in documentation and coding practices. By leveraging our proprietary integration, we gain valuable insights into areas where targeted improvements can be made. This data-driven approach helps hospitals enhance their revenue integrity and optimize their coding processes, resulting in improved outcomes.

    Collaborative and Transparent Audit Process

    At Brundage Group, collaboration and transparency are the cornerstones of our audit process. We understand that every hospital is unique and tailor our approach to align with your specific needs and goals. Our dedicated team works closely with your staff throughout the DRG validation audit, fostering a collaborative partnership built on trust and open communication.

    We initiate the audit process by thoroughly evaluating your existing clinical documentation and coding practices. This evaluation allows us to understand your organization’s strengths and areas for improvement. We conduct in-depth reviews, providing feedback on the accuracy and completeness of DRG assignments while ensuring compliance with coding guidelines.

    Throughout the audit, we maintain regular meetings and progress updates, keeping you informed every step of the way. Our open communication channels allow for meaningful discussions, enabling your team to gain insights into coding best practices and implement necessary improvements. By working together, we can drive positive change and ensure long-term success in revenue integrity.


    Intelligent DRG validation

    Hospital systems are struggling with capturing clinical documentation and coding opportunities, which often results in inaccurate DRG assigment.

    Our experienced physician advisors with coding expertise, combined with our proprietary data integration platform, help identify charts with the greatest opportunity to accurately capture earned revenue and mitigate compliance risk.


    DRG review with physician oversight

    Our clinically-driven DRG review solution examines the clinical validation of reportable diagnoses as well as coding accuracy to fix and prevent lost revenue. We continually improve the selection of charts to optimize effectiveness of the DRG review process.

    • Physician-led clinical DRG reviews are performed by physician advisors with years of clinical expertise and certified coders.
    • Clinical validation experts include physician advisors who are certified coders (CCS) and certified clinical documentation specialists (CCDS).


    Sustainable and lasting value

    • Physician oversight by trained physician advisors ensures documentation, CDI and coding compliance to reduce revenue leakage and secure accurate reimbursement.
    • Our physicians incorporate CDI and coding feedback and recommendations for best practices that can be incorporated into workflow.
    • Clinical DRG review services are backed by intelligent data integration to identify opportunities for targeted physician education.

    Data-driven DRG validation

    Our end-to-end solution identifies and addresses opportunities within the DRG assignment. Using our proprietary DRG integrated workflow, we select cases with a high likelihood of demonstrating opportunity to impact accurate reimbursement.

    We utilize our data integration in real time to offer ongoing value to clients by maintaining a dynamic approach to seeking continuous opportunities for improvement that clients can integrate into their processes and workflows.   


    Benefits of our DRG Validation Solution

    Physician-led clinical DRG reviews are an important part of the mid revenue cycle to ensure revenue integrity and relay high-quality care in public reporting. Physicians must document effectively to accurately reflect the patient population in claims data. Otherwise, hospitals risk commercial payor denials, inaccurate reimbursement and poor public perception.

    • DRG reporting uncovers trends and areas for improvement with ongoing monitoring and tracking of key metrics
    • Clients can get started quickly through our web-based solution with limited IT support required
    • Quick turnaround of DRG reviews to minimize bill holds


    Frequently Asked Questions

    What sets Brundage Group's DRG validation services apart?

    Brundage Group’s DRG validation services are distinguished by our physician-led approach, combining clinical expertise with in-depth coding knowledge. Our team of experienced physician advisors, certified coders, and clinical documentation specialists ensures accurate documentation and optimal DRG assignment, leading to enhanced revenue integrity.

    How quickly can we get started with Brundage Group's web-based solution?

    We understand the urgency of optimizing your revenue cycle operations. With our web-based solution, you can quickly implement our services with minimal IT support required. Our user-friendly platform enables seamless integration into your existing workflow, allowing you to experience the benefits of physician-led DRG validation without significant disruptions.

    What long-term value does Brundage Group provide?

    Brundage Group goes beyond immediate DRG validation services. Our proprietary integration platform continuously identifies opportunities for targeted physician education, ensuring ongoing improvement and long-term revenue optimization. We are committed to being your trusted partner in achieving sustained excellence in revenue integrity, compliance, and quality care.

    Why should I choose Brundage Group for DRG validation over other providers?

    At Brundage Group, our approach to DRG validation sets us apart. We combine the expertise of our experienced physician advisors, certified coders, and clinical documentation specialists to ensure accurate coding and optimal reimbursement. Our physician-led approach brings deep clinical knowledge to the table, enabling us to capture the complexity and acuity of your patient population.

    Additionally, our comprehensive analytics platform helps identify opportunities for improvement and targeted physician education, ensuring lasting value beyond immediate validation services. With Brundage Group, you can trust in our commitment to your hospital’s revenue integrity and the delivery of high-quality care.

    How quickly can we implement our DRG validation services?

    We understand the urgency of optimizing your revenue cycle operations. With Brundage Group, you can expect a streamlined and efficient implementation process. Our web-based solution allows for quick onboarding, minimizing the need for extensive IT support. We work closely with your team to ensure seamless integration into your existing workflow, enabling you to experience the benefits of physician-led DRG validation without significant disruptions.

    Our goal is to provide you with a swift and effective solution, so you can start reaping the rewards of accurate coding and capturing your earned revenue reimbursement as soon as possible.

    Partner with Brundage Group for Expert DRG Validation Services

    Brundage Group is committed to empowering hospitals with our physician-led DRG validation services. With our expertise, comprehensive analytics, and dedication to excellence, we ensure accurate coding and earned revenue reimbursement for our clients. Partnering with us means gaining a trusted ally that understands the complexities of DRG validation and is focused on delivering superior results.

    Experience the transformative power of physician-led DRG validation with Brundage Group. Elevate your revenue cycle operations, mitigate compliance risks, and secure the operating margins necessary to continue providing exceptional patient and community care. Trust in our expertise to safeguard your revenue integrity while maintaining the highest standards of quality care.

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