NEW YORK, Nov. 2, 2023 — Dr. Michael Menen, Chief Medical Officer at MedReview, Inc. – a leading provider of payment integrity, utilization management, and quality surveillance services – will present “A Historical Perspective of the Most Common DRG,” at this year’s National Health Care Anti-Fraud Association (NHCAA) Annual Training Conference (ATC) in Dallas, Texas. The talk will be held on November 7 at 3:30 PM CST.
Dr. Menen presents a thorough overview of the ongoing controversy surrounding definitions of sepsis, how it has become one of the most frequently coded Diagnosis-Related Groups (DRGs), and why. He addresses the crucial question the matter raises: Is the increase in sepsis DRGs due to a rise in disease prevalence, sicker patients, or incorrect or fraudulent coding practices?
Dr. Menen offers effective strategies for rectifying coding issues around sepsis and maintaining accurate billing. He will use a compelling case study to illustrate the misuse and upcoding of sepsis DRGs and demonstrate how clinical validation and claims review can ensure compliance and safeguard against coding irregularities.
“Sepsis is a severe, but not completely understood, medical condition, and a frequently coded, very high-cost DRG,” said Dr. Menen. “These facts make sepsis a prime target for upcoding, and often it takes a clinical validation process and a close look at the medical record to verify whether a sepsis DRG is justified–a process that potentially results in substantial savings for the payor.”
As CMO at MedReview, Dr. Menen provides clinical direction on behalf of the organization. In addition to developing innovative programs and strategic partnerships, he is ultimately responsible for ensuring programs are compliant, clinically accurate, and support both patients and clients.
MedReview is a proud sponsor of the NHCAA. In addition to Dr. Menen presenting at the conference, MedReview representatives will be at Booth #301 to answer questions and host a tequila pairing during the event. Learn more here.
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Headquartered in the financial district of New York City and serving all U.S. states and territories, MedReview has been a leading provider of payment integrity, utilization management and quality surveillance services for more than 40 years. A physician-led organization with a passion for ensuring that health care claims fairly represent the care provided, MedReview provides timely independent hospital billing audits and clinical validation reviews on behalf of health plans, government agencies and Taft-Hartley organizations, saving millions of dollars for its clients each year.