Revenue Cycle

A closer look into DRG validation issues

Recovery Auditor Report, February 4, 2010

Last December, the first sets of complex RAC review issues were released. Since then, the list has grown, as each RAC has released its own DRG validation issues.

The official definition of DRG validation, according to Connolly Healthcare, says that diagnostic and procedural information and discharge status of the beneficiary, as coded and reported by the hospital on its claim, matches both the attending physician description and the information contained in the beneficiary’s medical record.

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