Description

Description The purpose of DRG validation is to confirm that diagnostic, procedural information, and the discharge status of the beneficiary, as coded and reported by the hospital on its claim, matches both the attending physician’s description and the information contained in the beneficiary’s medical record. Responsible for performing quality reviews of medical records to validate correctness and appropriateness of the assigned International Classification of Diseases, 10th Revision (ICD-10-CM and ICD-10-PCS) codes and the Diagnosis Related Groups (DRG). The CRM reviews the physician documentation for specificity, completeness and quality to support coding accuracy, and to identify physician query opportunities to improve the documentation. The CRM will follow the official coding rules, guidelines and conventions to validate coded data and ensure high quality and compliance with regulatory requirements. The CRM works in conjunction with the Associate Director and Director of DRG Validation to help develop coding education and training and institutional coding policies to achieve coding excellence. Responsibilities Performs SMART focused ...