DRG Validation

Capture revenue other solutions don’t find

Ensure your coding and documentation are optimized for full reimbursement and compliance with our industry-leading solution. DRG Validation is your safety net to maximize earned reimbursement, quality, and compliance. With the most experienced team in the industry backed by powerful analytics and intelligent rules-based algorithms, we help you recover more revenue and speed payer reimbursement.


DRG Validation Advantages

Revitalize your revenue cycle with teams of credentialed auditors reviewing 100% of inpatient cases. R1 DRG Validation delivers a comprehensive review of patient demographics, clinical documentation, diagnosis coding, procedure details, charge entries and physician billing, identifying DRG shifts and New Technology Add-On Payment (NTAP) opportunities that other solutions miss.

Boost efficiency

Identify DRG opportunities faster with proprietary rules-based algorithms enabled by robotic process automation (RPA) and machine learning.

Eliminate costly oversights

Recover every missed opportunity with help from the largest credentialed inpatient auditing team in the country.

Work smarter long-term

Benefit from measurable process improvements in case mix index (CMI), accuracy, compliance, and quality.

Create long-lasting value with a strategic partner

Partner with R1 to tackle DRG complexities and help your team work smarter and faster with the most comprehensive and accurate DRG review and recovery solution available. Here’s how we work together as partners:

You provide high-level inpatient information using our universal data spec (UDS). Automated file extracts are delivered to your audit team weekly. Pre-bill or post-bill flexibility complements current clinical documentation improvement (CDI), computer assisted coding (CAC), or coding processes.

We validate the information and run it through our proprietary rules and machine learning algorithms. We review medical records and provide justification for all recommended DRG shifts and NTAP opportunities.

Intuitive dashboards monitor and identify DRG shifts for staff to review, change, and bill in real-time. Our invoicing team monitors rebilling and resolution to maximize reimbursement.

Robust reporting and root cause analysis equip you to better manage your workflow, team, and ongoing education efforts. Leverage our deep expertise across multiple payers and providers to implement changes quickly.

Looking to learn more about us? It all starts here.