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DRG Validation

DRG Validation
The DRG (diagnosis-related group) indicated on a medical bill determines the cost of care. However, our experience is that approximately one in five claims has the wrong DRG. At HHC, our DRG Validation service relies on an examination\review of the diagnostic and procedure codes within the claim to determine the correct DRG. Once we determine the proper DRG, we compare it to the DRG on the medical bill to ensure consistency. If they don't match, we determine the reimbursement for both DRGs and allow the client to determine how to proceed with payment.

For a more in-depth analysis, send us the patient's medical record. We will have our certified coders recode the claim based on the medical records, and advise you as to how the claims should have been coded and the price difference between the providers coding and our analysis. You can compare the coding for yourself and once you agree, we will be happy to contact the provider to discuss how and why they coded the claim as they did? Additional fees apply for this service.

Any of our Medical Bill Review services may be used independently or with other HHC services to achieve maximum savings. Contact HHC today to learn more.