DRG Audits for Health Insurance Industry
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DRG Audits

Verscend can retrieve and audit your inpatient claims to identify incorrect coding and overpayments made due to DRG billing errors.

Financial Recovery

Verscend understands the importance of performing consistent reviews of paid claims to determine the accuracy of payments. Our financial recovery department has a team of experts who perform coding audits on claims submitted by providers, as well as inpatient and outpatient facilities. Our financial recovery auditing services include:

Scrubbing of all Claims

Provide us with your paid claims data and our scrubbing software has built in logic that identifies potential concerns in billing, then flags claims that should undergo a more detailed coding audit.

Detailed Coding Audit

Verscend will retrieve medical records identified for a detailed audit and determine the accuracy of the codes submitted to the plan for payment. This includes a review of CPT, ICD-9, HCPCS, and DRG codes.

Submission of Findings to the Provider

Once we have completed our review, Verscend will submit a letter of findings to the provider or facility outlining the reasons for any coding changes.

Appeals on Audit Findings

Verscend works with your providers and facilities if an appeal of our findings is made. Our team will review all documentation submitted with the appeal and supply the findings to the client.

Fraudulent Billing Identification and Reporting

Throughout the auditing process, our team consistently looks for any potential areas of fraudulent billing. Any areas of concern will be reported back to the health payer.

DRG Audit Services

  • Financial Recovery
  • Scrubbing of All Claims
  • Detailed Coding Audit
  • Submission of Findings to the Provider
  • Appeals on Audit Findings
  • Fraudulent Billing Identification and Reporting