Solutions and Services
Medicaid and Health Exchange Applications
Self Pay Insurance Eligibility Scrubbing
DRG Appeal Services
DRG appeals are cases that are not paid at the DRG billed because the Payer has grouped the inpatient stay to a different DRG.
Our Coders/Clinicians will:
- Clearly state the disputed DRG, the proposed DRG, and the payer’s reason for the denial.
- Cite specific guidelines from official sources.
- Provide direct documentation references from the medical record that support the original coding or provide a summary of why the Clinician/Coder agrees with the change.
- Explain why the original DRG is the most appropriate classification based on the coding rules and patient’s record and request its reinstatement.