SERVICES PROVIDED TO THE MANAGED CARE INDUSTRY:
Payment Integrity Audits
DRG Claims Management (DCM) has been offering cost containment solutions to health plans across the United States since 2013. Services include post-payment model focused on addressing inaccurate coding and clinical errors retrospectively, maintaining good relationships with providers, and ensuring a smooth refund request process. DCM's prepayment model is preferred by health plans to prevent overpayments, reduce turnaround time, increase provider response, and ensure the audit of out-of-network claims.
Why DRG Claims Management?
DCM differentiates from their competitors with customizable solutions and customer service. They offer their clients white glove services, with the following metrics:
$20 PMPM Savings: Strategic impact on cost reduction.
40% Audit Hit Rate: Nearly one-third of all records audited lead to actionable insights.
96% Medical Records Acquisition: Effectively obtaining the necessary documentation.
95% Accuracy Rate: Precision underlines every audit decision they make.
Products/Services:
DCM audits:
Hospital Claim Audits (MS/APR-DRGs & APCs)
Readmissions
Short-stay/OBS
Cost outlier & Itemized Bill Audits
SNF reviews (RUG/PDPM)
Surgical implants
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