Physician-Led DRG Validation

Led by clinical expertise, powered by analytic insights

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.


    • Quick turnaround of DRG reviews
    • 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

    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 analytics 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).


    Education and lasting value

    • Physician oversight by trained physician advisors ensures documentation, CDI and coding compliance to prevent denials and secure accurate reimbursement.
    • Clinical DRG review services are backed by our proprietary, concurrent analytics that identify opportunities for targeted physician education.

    Analytic-driven DRG validation

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


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