IPDRG Coding
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 prospects.
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.