DRG Coding Reviews/ Clinical Validation

Save millions with our meticulous review process.

The submission of medical claims with DRG coding errors that are followed up by insufficient clinical documentation is an exceedingly common problem that can have a substantial impact on the revenue cycle for payors and providers alike.

The only way for payors to verify claims and render accurate payments is to validate DRG coding and conduct detailed clinical reviews comparing claims to medical records. To accurately validate a DRG code and ensure it represents the correct diagnosis and severity, our physician-led team compares the code to the supporting administrative and clinical documentation corresponding to each code.

This process comes with our guarantee that every DRG reassignment is determined and documented by our board-certified physicians.

As a clinically driven organization with an extensive team of certified DRG coders, registered nurses and board-certified physicians representing every medical specialty, MedReview is one of just a few companies to offer both DRG coding reviews and clinical validation to ensure payment integrity.

DRG Coders
DRG Coders

In addition to leading the industry in coding proficiency and clinical expertise, our DRG Coding Review and Clinical Validation program is backed by the latest advances in artificial intelligence (AI) and machine learning (ML), with proprietary algorithms that can instantly recognize suspicious trends in the data and automatically target claims with the highest potential for waste and abuse.

This unique combination of advanced technology and clinical expertise is what sets MedReview apart, allowing us to recover billions of dollars for our clients while minimizing provider abrasion.

100%

of our reassignments are physician reviewed

40%

or greater reassignment rate

5%

or less appeal overturn rate

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