DRG - Diagnosis Related Groups

• Reported diagnoses and treatments are matched to the industry standard DRG codes for evaluation of treatment. DRG codes are adjusted for patient condition, age, complications or discharge status.
• Reimbursement is based on geographical region of the facility where service was rendered and the assigned DRG code.

RBRVS - Resource Based Relative Value System

• This pricing option is available in situations where a DRG's pricing option is not available and uses standard US Federal Register data for each year to base payment recommendations.

Ambulatory Surgical pricing

• NY PAS codes supported
• DRG or Outpatient HCPC coding available depending on case. Bills are evaluated for proper use of ICD-9, HCPC's and Rev codes

Pharmacological charges and Supplies are reviewed

• AWP pricing available when not included in DRG reimbursement.

DME

• Payment recommendations provided separately when not included in DRG criteria.

Medical review for appropriateness of care and medical necessity

• All Inpatient and Ambulatory bills are evaluated by our medical staff to ensure continuity of care; medical necessity and accident or injury relatedness
• Medical records are compared to UB92 form to ensure proper billing and coding.