Clinical DRG Validation

Led by clinical expertise, powered by analytic insights.

Pre-bill 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.

What’s the problem with your current process?

Hospital systems are struggling with clinical validation denials that result in DRG downgrades. Clinical validation denials are a clinical issue that impact the coding of the medical record. DRG validation reviews do not address the root problem of ineffective documentation or offer a true solution for pre-bill DRG reviews.

Intelligent DRG validation

Accurately capturing the correct DRG in a timely manner is critically important. DRG validation helps hospitals achieve more accurate patient acuity and increase case mix index (CMI).

As with all Brundage Group services, our clinical DRG reviews focus on creating compliance across hospital departments. Our comprehensive pre-bill reviews are conducted by physician advisors, leveraging clinical expertise to identify improvement opportunities in CDI, quality and UM/UR while providing DRG optimization, query opportunities, and physician and coder education.

Coding-driven review with physician oversight

Our end-to-end DRG solution is analytics driven to identify and address the root cause of DRG downgrades. We help clients implement a clinically driven DRG review solution that examines the clinical validation of reportable diagnoses as well as coding accuracy to fix and prevent lost revenue streams.

• Pre-bill clinical DRG reviews are performed by physician advisors, based on sound medical evidence.
• Clinical validation experts are physician advisors who are certified coders (CCS) and certified clinical documentation specialists (CCDS).

Education and lasting value

We deliver ongoing value to our clients by providing physician documentation, CDI and coder education with DRG reviews. Our clients see up to a 200% return on investment from our clinical validation denial services.

• 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.

The benefits

• 24-hour turnaround of pre-bill DRG reviews
• DRG dashboard uncovers trends and areas for improvement with ongoing monitoring and tracking of key metrics
• Additional query opportunities and support provided
• Clients can get started quickly through our web-based solution with limited IT support required

Analytic driven DRG validation

Using our proprietary DRG analytics dashboard, we can focus on the areas of the mid revenue cycle that are impacting DRG downgrades and inaccurate revenue reimbursement.

Data points include:

• Breakout by physician service line
• Percentage of cases without CC/MCC or full, effective documentation
• Sorted by average length of stay (GMLOS)
• Benchmarked against peers

Contact us to request pre-bill clinical DRG validation services.