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
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
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
Contact HRSM Consulting
Request a Consultation
Tell us about your organization and the support you’re looking for. We’ll be in touch to discuss next steps.
mailto: RVelazquez@hrsmconsulting.com
Phone: 908-635-4014
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