DRG validation strategies for success
Research shows that the vast majority of medical bills contain errors—health plans can use DRG validation audits to improve the accuracy and validity of claims payments.
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Prevent losses and recover funds
Bills for non-covered services, duplicate charges, wrong codes, and more create significant financial and compliance risks for your health plan.
Our Clinical Audits solution analyzes and reviews healthcare claims to detect and deter billing errors, helping to take out waste from your overall claims spend. Using proprietary audit and data mining algorithms backed by expert clinical reviewers, we accurately evaluate the cost and clinical appropriateness of charges before and after they’re paid, delivering timely turnarounds and a high rate of successful outcomes.
The latest in Clinical Audits
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Caring for providers during clinical audits
Clinical audits play a critical role in ensuring health plans’ financial health. Recognizing that these audits have the potential to cause provider abrasion, communication and education should be part of a health plan’s clinical audit program.
Ways we help
Technology
Our highly flexible proprietary system provides secure pre- and post-claims payment analysis, identifies erroneous claims and overpayments, spots pricing errors, manages recoveries, and delivers custom reports.
Expertise
Our seasoned medical experts and clinical auditors know how to work with your provider networks and unique policies to increase positive outcomes and maintain healthy relationships.
Recovery
Our tools and people take the hassle out of finding billing discrepancies, saving you valuable time and offering greater recovery potential.
What you get with Clinical Audits
Trusted partner
We are with you every step of the auditing process—from claims analysis to clinical review and provider communication to final recovery.
Custom analyses
Our Clinical Audits solution supports a variety of services and claims types according to your plan’s specific provider contracts to maximize efficiencies and recoveries.
Provider sensitivity
Our collaborative approach to conducting clinical audits includes a high level of provider sensitivity to increase engagement and alignment.
Audit findings
Detailed audit findings show opportunities to update flaws in your coding or billing processes and minimize future billing errors.
Discovery’s Clinical Audits solution improves the identification and recovery of overpaid claims and improper bills, leading to greater compliance and financial performance
Your Clinical Audits partner
Recover and restore value to get the revenue you deserve and make healthcare more affordable.
Prevent
Minimize future billing errors with process updates
Correct
Detect and deter overpaid claims and improper bills
Recover
Increase compliance and financial performance
Related resources
The impact of telehealth on clinical audits during COVID-19
Telehealth has become a lifeline during the pandemic, but the potential for improper coding and documentation is high. Health plans are wise to include telehealth claims in their clinical audit programs.
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Three benefits of physician oversight in clinical audits
Our Medical Director discusses the role physician oversight plays in conducting medically sound audits that reduce provider abrasion and ensure defensible recoveries.
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Trends that are re-shaping payment integrity strategies
Discovery is helping health plans transition to a more proactive, data-driven payment integrity approach.
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Caring for providers during clinical audits
Transparent communication and education are key to positively impacting the provider experience during clinical audits.
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Merging AI and human intelligence for big recovery results
Hear Chief Information Officer Dan Iantorno on how Discovery uses artificial intelligence to uncover clients’ best opportunities for bigger recoveries.
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Protecting payment integrity through client-centered support
Discovery discusses how our client-centric approach to account management helps protect payment integrity.
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Infographic: Fixing payment integrity at the source
Are eligibility errors impacting your payment integrity approach? Find out the top three causes of eligibility errors and what they might be costing your plan.
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Fixing payment integrity at the source
Find out how eligibility management plays a role in maximizing recovery opportunities, improving cost avoidance strategies, and creating premium restoration possibilities.
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Jason Brown on the road ahead for payment integrity
Health plans face increasing pressure to ensure payment integrity. Discovery CEO Jason Brown explains recent trends and how they’re shaping the new decade.
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Contact us today for more information on accelerating your payment integrity results
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