Identify Overpayments
Providers frequently group cases to the wrong DRG, which can trigger a claim overpayment if the appropriate DRG pays less than the paid DRG. With DRG Audit Services, health plans gain valuable insight into provider coding and claims management practices and their general compliance with prevailing OIG guidelines
Benefits
- Audit results improve provider coding
- Reduce administrative expenses
- Proactively manage the entire DRG process
Focus Revenue Recovery Efforts
Changes in DRG methodology, coupled with the shortage of experienced and qualified coders, can potentially lead to incorrect DRG assignment. Payers that take a proactive approach to claim overpayments typically use DRG Audit Services to identify suspect DRGs and focus their revenue recovery efforts where they’ll realize the highest return.
Improve Provider Relations
With DRG Audit Services, payers can objectively identify overpayments on claims with incorrect DRG assignments. This information can be used to educate providers about their coding practices to avoid future occurrences.
