Optimization Suite

DRG Validation

Ensure coding and documentation are optimized for reimbursement and compliance with Cloudmed’s award-winning Revenue Intelligence™ solution for DRG validation, powered by the CloudmedAI™ Platform.

Request a Demo

Capture millions in missed revenue

Cloudmed DRG Validation is your safety net to maximize reimbursement, quality, and compliance. With the most experienced team in the industry backed by the powerful CloudmedAI Platform, Cloudmed helps you recover more revenue, faster.

overview path

DRG Validation Overview

Optimize your back-end revenue cycle with credentialed auditors reviewing 100% of inpatient cases. Cloudmed DRG Validation delivers a comprehensive review of patient demographics, clinical documentation, diagnosis coding, procedure details, charge entries, and physician billing, identifying DRG shifts and New Technology Add-On Payment (NTAP) opportunities that other solutions miss.

Cloudmed DRG Validation optimizes back-end revenue for health information management and patient financial services leaders.

Boost efficiency by 20x

Identify DRG opportunities faster with proprietary rules-based algorithms enabled by robotic process automation (RPA) and machine learning.

Eliminate costly oversights

Recover every missed opportunity with help from the largest credentialed inpatient auditing team in the country.

Work smarter long-term

Benefit from measurable process improvements in case mix index (CMI), accuracy, compliance, and quality.

The Cloudmed Difference

DRG Validation Results

100%

Of inpatient cases reviewed

1-3%

Discovery rate

90%

Average findings agreement rate

20x

More effective than manual audits

*Representative customer results

Keep improving for long-lasting value

Partner with Cloudmed to tackle DRG complexities and help your team work smarter. Here’s a look at how we work together:

Startup

You provide high-level inpatient information using our universal data spec (UDS). Automated file extracts are delivered to your Cloudmed team weekly. Pre-bill or post-bill flexibility complements current clinical documentation improvement (CDI), computer assisted coding (CAC), or coding processes.

Review

We validate the information and run it through our proprietary rules and machine learning algorithms. We review medical records and provide justification for all recommended DRG shifts and New Technology Add-On Payment (NTAP) opportunities.

Recovery

Intuitive dashboards monitor and identify DRG shifts for staff to review, change, and bill in real-time. Our invoicing team monitors rebilling and resolution to maximize reimbursement.

Continuous Improvement

Robust reporting and root cause analysis equip you to better manage your workflow, team, and ongoing education efforts. Leverage Cloudmed’s deep expertise across multiple payers and providers to implement changes quickly.

Ranked #1 by KLAS

We’re proud to be recognized for outstanding performance and excellence in customer satisfaction. In the Revenue Integrity / Underpayment Services segment, our clients rated us:

A+

Loyalty

A+

Operations

A

Services

A

Relationship

A+

Value
*Cloudmed is the 2021 Best in KLAS® in the Revenue Integrity/Underpayment Services and Robotic Process Automation (Databound) segments.
2021-Best-in-KLAS-Revenue-Integrity-Underpayments
2021-best-in-klas-robotic-process-automation

Optimization Suite

Capture missed or underpaid revenue for the care you provided, across the entire revenue cycle, with our comprehensive payment review that catches what others miss.

DRG Validation

Ensure coding and documentation are optimized for reimbursement and compliance.

Learn more

Charge Capture

Identify inconsistencies in coding, charging, and billing to find missed reimbursement.

Learn more

Underpayment Recovery

Improve revenue collection by identifying and recovering underpaid revenue.

Learn more

Transfer DRG

Find revenue lost through the Transfer DRG rule and recover underpayments.

Learn more
overview path

Learn More

Find out how Cloudmed DRG Validation Revenue Intelligence solution helps ensure coding and documentation are optimized for reimbursement and compliance.