- Review inpatient medical records and accurately assign ICD-10-CM, ICD-10-PCS, CPT, and DRG codes.
- Ensure coding accuracy and compliance with established coding guidelines, regulatory requirements, and payer standards.
- Review clinical documentation to identify appropriate coding opportunities.
- Ensure accurate capture of MCCs, CCs, diagnoses, and procedures.
- Meet defined quality, accuracy, and productivity targets.
- Identify documentation gaps and collaborate with physicians/clinical teams for appropriate clarification.
- Maintain up-to-date knowledge of ICD-10 coding guidelines and DRG methodologies.
DRG Validation
- Conduct detailed DRG validation reviews of inpatient medical records.
- Validate diagnoses, procedures, MCC/CC capture, and overall DRG assignment.
- Identify coding discrepancies, clinical validation issues, and potential reimbursement risks.
- Review clinical documentation to ensure diagnoses are clinically supported and appropriately coded.
- Ensure compliance with CMS, ICD-10, payer-specific guidelines, and reimbursement methodologies.
- Conduct quality audits and document findings accurately.
- Provide recommendations for coding accuracy, compliance, and process improvement.