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.

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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.

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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


Of inpatient cases reviewed


Discovery rate


Average findings agreement rate


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:


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.


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.


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.

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.

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Charge Capture

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

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Underpayment Recovery

Improve revenue collection by identifying and recovering underpaid revenue.

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Transfer DRG

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

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

Discover top trends affecting the revenue cycle – and how to address them –  with the 2023 Revenue Intelligence™ Data and Insights Report.