DRG Validation


 

Reimbursement Returns

DRG (Diagnosis Related Groups) Validation is an important tool for controlling healthcare costs. HealthMind uses a broad spectrum of technical, clinical and practical applications to provide DRG Validation services that deliver returns and improve bottom line savings.

DRG Validation involves in-depth clinical review by our highly experienced and credentialed coding professionals. To identify coding and sequencing errors that impact DRG assignments, we use our proprietary Dynamic Discovery™ technology  to analyze paid claim data in search of anomalies. Once revealed, the audit team requests medical records, lets the provider know which claims are in dispute, and begins its thorough examination of the data provided. Our certified specialists know the most effective way to present data to ensure a timely turnaround,  provider transparency and successful outcomes.

 

How It Works:

  • Pre-Paid claim data is analyzed for anomalies such as mismatched diagnosis and procedure codes

  • Once identified, medical records for coding audit are requested
  • Facility is provided with a thorough explanation of coding issues and submits any other relevant documentation to HealthMind
  • Auditors conduct in-depth examination of all data
  • Provides a compelling and easy to understand ROI
 
 
 

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