DRG Claims Management Reviews

DRG Claims Management Description

It is fair to say that not all DRG vendors will be created equal. Despite overlap in marketing efforts, there are two main categories of DRG auditing products. Those that primarily serve provider hospitals are those that are designed for payers and health plans to identify overpayments. Auditing vendors are specialists in the specific needs, cultures, and priorities of the parties they serve, much like an attorney specializes in plaintiff representation or defense. There are many approaches to DRG auditing or overpayment identification, even within the payer-based vendor category. Our physician review team is also included in our scope of services. We can produce clinical validation findings when the identified issues are not supported by documented clinical diagnoses from treating physicians. This extends our scope of services beyond the scope of coders. Our results show that our coding compliance model will result in verified savings.