DRG Coding Services

In a study of 239 hospitals under the Medicare program, Hsia et al. identified the rate of DRG coding errors to be 20.8%, of which 61.7% significantly favored the hospital. Discrepancies between the submitted codes and the information in medical records, especially when the submitted codes can result in larger reimbursements than would be consistent with the actual condition, cannot just lead to denials but also trigger concerns about quality of medical records, cooperation of physicians, knowledge and skill of coders, as well as hospital intentions to "game the system" (also known as "DRG Creep"). In spite of not being deliberate, such errors can call for unnecessary audit.

Thus, it is imperative to implement a suitable process for in-patient billing to ensure that the most appropriate codes are submitted and that the record clearly supports all codes reported, serving to raise the DRG with clinical evidence and maximizing reimbursement, at the same time prevent chances of audits and reduce denials.

At CureMed Solutions,

• Our coding professionals are formally trained and experienced in MS-DRG coding.
• Our DRG coders carry out comprehensive review and recoding of medical charts of the provider to ensure the appropriate DRG is reimbursed by the payer.
• Codes are assigned keeping into account the principal and secondary diagnoses, procedure, discharge status, age and sex that describe the patient’s conditions, complications and co-morbidities.
• Our in-patient coding and CDI teams work together proactively towards achieving maximal DRG coding also strengthening the record content.
• We work by means of maintaining all compliances, abiding by ethical guidelines and approved DRG coding guidelines.
• We also provide compliance audit services to ensure that our clients have up-to-date coding audit results to meet the compliance requirement and help healthcare organizations minimize financial risk, and manage the revenue cycle.