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DRG Validation & Review Services 

CBIZ provides focused, detailed reviews to achieve the highest level of compliance and revenue capture.

Blending expertise in inpatient coding and data analytics with over 40 years of revenue integrity consultative engagements, our reviews uncover and address two issues that strongly impact data quality: lack of supporting documentation and inconsistent coding. Because of the pressure to drop a bill in a timely manner, the record is often coded with incomplete, unclear or insufficient patient treatment information, which results in incorrect coding.

Our Services:

Identify OPPORTUNITIES for improvement.
Identify EFFECTIVENESS of revenue capture
Identify areas for FOCUSED education.

As part of our reviews, CBIZ can utilize proprietary data analytics to identify at-risk cases. This enables us to focus on specific areas of risk. We can perform reviews on a one-time basis, or more regularly, such as monthly, quarterly or annually, especially in conjunction with annual compliance plans.

Our experienced certified coders perform a comprehensive review of provider documentation, validating the documentation to see if it supports the codes assigned for billing. Detailed reporting is provided back to the institution identifying variances, opportunities for improvement and areas for focused education.

Our approach provides a detailed review of coding that will monitor compliance with standard coding practices, provide a review of documentation and will identify the effectiveness of revenue capture.