CHARACTERISTICS OF A SUCCESSFUL AUDITING PROGRAM

  • Assisting health plans to include contractual language with providers to protect audit rights.
  • Screening transmitted claims data that includes ALL DRG claims regardless of billed price or a payer’s internal review filters.
  • Auditing retrospectively as per CMS guidelines, unless contractually limited.
  • Providing creative and customized options for both pre-payment and post-payment auditing.
  • Providing the full scope of coding and diagnosis auditing, including physician reviews for clinical validation.
  • Utilizing technology and proprietary sets of coding-based algorithms, along with manual analysis, to identify the claims with the best recovery potential. This is akin to filtering “with a finely toothed comb”, which is reflected in our results that exceed average industry standards.
  • Employing only coders with the highest AHIMA credentials, college level education, and extensive hospital experience in DRG coding.
  • Creating and fostering positive provider relationships through credible and respectful communications and dialogue.
  • Obtaining provider-signed confirmation/agreement of audit results, thereby eliminating appeals and disputes, and ensuring recovery.

DRG Claims Management brings our clients all of this and more!

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