DRG/Clinical Chart Audit
Office of Inspector General conducted a study on Inpatient hospital stays and found that the number of stays at the highest severity level increased almost 20 percent from FY 2014 through FY 2019, ultimately accounting for nearly half of all Medicare spending on inpatient hospital stays. Stays at the highest severity level are vulnerable to inappropriate billing practices. Specifically, nearly a third of these stays lasted a particularly short amount of time and over half of the stays billed at the highest severity level had only one diagnosis qualifying them for payment at that level.
Most Payers, along with their Vendors and internal audit teams, conduct prospective and retrospective clinical review and validation of inpatient Diagnostic Related Group (DRG), Short Stay (SS), and readmission claims. The audits are conducted by highly skilled personnel that are in demand and difficult to hire. However, due to the lack of appropriate technology, most of these skilled auditors work on manual tasks that result in lower productivity.
AuditShark|DRG audit platform helps maximize the audit potential and skills or the auditors by providing them with technology and automation to improve accuracy and productivity. Our audit platform has features like workflow, edits, clinical data extraction from voluminous charts and insights to help audit accurately and efficiently.