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OVERVIEW
Acute care hospitals are seeing an increase in the volume of Diagnosis Related Group (DRG) audits and downgrades. Payers and their third-party auditing agencies are intensifying their audit practices related to Medicare Advantages, Medicaid Managed care and commercial plans with DRG-related payment structures. Across the industry, organizations are seeing an increased revenue loss that is far broader compared to the medical necessity denials that were already a common challenge.
In this webinar, McBee expert Shirley Vazquez will dive into DRG downgrades, including fundamentals, key strategies to establish a workflow, tracking and trends your organization should be aware of in 2023. In addition, Shirley will review approaches to improving your overturn rate with a strategic approach and clinical references for more common DRG downgrades.
LEARNING OBJECTIVES
- Understand and review growing DRG downgrades
- Discover audit trends
- Create best practices to track and appeal DRG downgrades
- Strategies to improve overturn rate
SPEAKER
Shirley Vazquez
Senior Manager, Denials Management