DRG VALIDATION

Independent, clinically driven DRG validation focused on ensuring accurate MS-DRG assignment and severity capture. Reviews are aligned with ICD-10-CM/PCS guidelines, AHA Coding Clinic guidance, and payer audit standards.

Use cases (optional second line):

Pre-bill and post-bill DRG validation

  • Targeted service line reviews

  • Audit risk identification and mitigation

Audit Defense & Appeals Support

Clinical and coding support for payer audits, DRG denials, and medical necessity reviews. Our approach is evidence-based, guideline-supported, and defensible at every level of appeal.

Use cases:

  • RAC, MAC, and commercial payer audits

  • DRG downgrades and recoupment prevention

  • Clinical appeal letter development

Clinical Documentation Integrity (CDI) Support

Comprehensive CDI support designed to strengthen clinical documentation, improve physician query effectiveness, and ensure documentation accurately reflects patient complexity and resource utilization.

Concurrent and retrospective CDI reviews

  • Provider education and query optimization

  • Program assessment and enhancement