DRG Validation Services

The Issue
As insurance companies and employers look deeper for opportunities to reduce their medical costs, another area of possible exposure is that of inaccurate DRG assignments, which can result in duplicate payments, overlapping confinements and non-conformance with the medical record, which can all impact a payer’s bottom line.

The Solution
Viant’s DRG Validation Services ensure that the diagnosis and procedure codes which generate the DRG, and therefore, the hospital invoice, are accurate, valid and sequenced in accordance with national coding standards.

Value Points

• Effective post-payment cost control for large facility bills with minimum repercussions
• High success rate and high average dollar savings per successful claim
• No minimum claim size threshold
• Signed agreement with provider on each claim; minimal provider appeals and back-end “noise”
• Reviews are customized and targeted based on the DRG-related terms of client’s contracts
• Readmissions, transfers and duplicate paid claims are identified and reviewed for appropriate reimbursement

How It Works
DRG Validation Services claims are first screened for codes, or combinations of codes with high savings potential. Viant analysts ensure that the diagnosis and procedure codes are accurate and valid based on medical records. If the analyst identifies a coding error, then a revised DRG is assigned by Viant and submitted to the provider for approval. If the submitted documentation supports the original DRG, the client receives a final disposition indicating the original DRG assigned by the provider is accurate. All DRG analysts are AHIMA accredited with a minimum of five years of provider-side coding experience.

Advantages

• The average discount rate on successful claims is over 41%
• Top-tier clients experience savings discounts of over 45%
• Average dollar savings equates to approximately $5000 per claim
• Viant DRG Audit Services review over $250 million in claims annually
• A 30-day closure policy based on stand-on-audit savings to reduce turnaround time

Summary
DRG Audit Services is a "must" if reimbursement terms with providers are based on a DRG assignment. To learn more about Viant’s DRG Validation services, call us today at 800.820.5824.