Physician-Led DRG Validation

Led by clinical expertise, powered by data integration

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

    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.   


    Related Blogs

    Your partner to compliantly capture earned revenue