Course Detail: DR1000 - DRG and Clinical Validation Program

The DRG (MS DRG and APR DRG) validation is to verify that all diagnoses and procedure codes were coded appropriately in accordance with official coding guidelines and were consistent with the documentation in the medical record resulting in accurate DRG assignment and reimbursement. This review validates all data elements that affect the DRG assignment. Coding validation is the process of verifying that codes were billed and sequenced in accordance with coding guidelines. Clinical validation is an additional process, and is performed in addition to the coding validation review. Clinical validation verifies that the diagnoses coded were actually present based on the clinical documentation in the medical record, and the results of related diagnostic testing were consistent with the diagnoses. In cases in which there is a conflict between the diagnosis coded, and the associated clinical indicators for that condition, the diagnosis will be removed from the grouping which may result in assignment of a DRG that more appropriately reflects the medical documentation. The purpose of the DRG validation review is to validate the principal and secondary diagnoses to ensure all diagnoses were billed appropriately, supported in the medical record, and billed according to official coding guidelines. Validate that the clinical documentation and results of diagnostic testing support the diagnoses and all procedure codes to ensure they were coded accurately according to official coding guidelines, and are supported by the documentation in the medical record. Verify the discharge status code and all other data elements affecting the DRG assignment; and verify diagnoses identified as HAC's were coded with the correct POA indicator.Must be a CCS, RN, or MDBooks RequiredICD 10 PCS and CM (latest edition) *Potential job placements are available upon successful completion of the program.*

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