DRG Validation

DRG validation, a program used by healthcare organizations to reduce risk, defend claims and ensure accuracy of coded items, plays a specific role in proper coding practices. The purpose of DRG validation is to confirm that all patient information coded and reported by a hospital on its claim matches both the attending physician’s records and the information contained in the beneficiary’s medical record. Therefore, DRGs can help coders understand the broad coding classification of conditions and services for easier comparison and assignment into payment categories.

Here’s what you should know about DRG validation systems as they relate to coding:

DRG implementation options. It’s important to understand your organization has options regarding the implementation of DRG validation, as you can choose to use either internal coding staff or an outside vendor. If your hospital outsources its coding, you should confirm your vendor has an internal coding quality review process in place. And, if you do use internal staff for implementation, it is helpful to periodically contract for independent DRG validation.

Communication and documentation. Effective DRG validation involves continually tracking findings and measuring outcomes to prevent future coding errors. A significant part of this process requires close attention to electronic medical records to make sure they are accurately capturing patient data. In addition, you should evaluate any system issues at your organization that may affect the flow of data from registration to coding and billing procedures.

Continuing education and training. As DRG validation guidelines and procedures continue to change, all coders require regular training and instruction. Your organization can demonstrate a commitment to its coders by providing continuing education opportunities on the entire documentation process, covering topics such as adherence to coding guidelines and knowledge of disease processes. If your organization can’t afford extensive in-house training, consider giving your coders a certain amount of paid time off each year so they can attend education or training sessions.

Achieving effective coding and reimbursement procedures within your organization is highly dependent on the proper facilitation of DRG validation. Making sure you employ the most skilled and qualified coders to handle the DRG validation process is critical for your organization’s patient documentation, and most importantly, your bottom line.

Are you lacking coders who are equipped for DRG validation?

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