Medical coding has a direct impact on the final hospital billing and claim reimbursement. Hence it is necessary to ensure compliance, accuracy and quality of clinical documentation, to ensure appropriate reimbursement. Any error occurred in this respect result in improper reimbursement and sometimes may lead to legal issues which result in monetary fines and penalties.

How can Data Marshall Help?

The DRG Audit services offered by Data Marshall ensure proper assignment of MS-DRG’s and realization of the appropriate reimbursement for services rendered to patients, during their hospitalization, in acute care facilities by avoiding Underpayments & addressing documentation compliance issues. DRG audit process helps to identify the error patterns in documentation and improper diagnosis, procedure code assignments which affect proper DRG selection.

Data Marshall performs ‘Pre-Billing’ and ‘Post-Billing’ coding reviews.

Our Approach

• Proper assignment of primary diagnosis code and primary procedure code, which derive correct MS-DRG for total hospitalization.
• Proper assignment of MCC, CC and other secondary diagnosis codes, which influence proper MS-DRG selection.
• Process of ‘Optimization’ for MS-DRG selection as per Regulatory Guidelines and Reporting requirements for Inpatient services and ICD-9-CM guidelines.
• Documentation standards to improve quality of documentation by identifying more specific and missing information, which will affect MS-DRG selection
• Correct discharge disposition code assignments, which will affect per diem payment process in case of inter facility transfers.

Benefits

• 40 – 50 % Cost Savings
• Higher Payment ($) realization through proper Coding Techniques.
• Ensure compliant based coding in order to reduce denials.
• Regular Performance Reporting emphasizing the areas of Improvement.

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