Solving the Rubik’s Cube of DRG and Clinical Validation

Greg Dorn, President & Mark Johnson, SVP Product Management

January 19, 2023

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Solving the Rubik’s Cube of DRG and Clinical Validation

Long-standing challenges with solutions that continue to advance.

Foreword

As we look to the coming year in healthcare, it will definitely be interesting. Payers, providers, and employers we have spoken to have a lot on their mind – lowering the total cost of care, staffing challenges, regulatory changes, high inflation, economic pressure, political conflict, rapidly changing tech, public health, supply chain disruptions, employee wellbeing, healthcare affordability, uncertainty, increasing competition – and the list goes on.

For CERIS, this means we must share the new capabilities we diligently advanced in 2022 to help our clients continue to build on existing payment optimization solutions in a simplified manner. As the healthcare ecosystem was drastically changing and codes and technology continued to advance, we set our sights on new ways to deliver more effective solutions that strengthened provider relations and focused on everyone working together for the greater good.

One of our big investments in 2022 was in DRG Audits, specifically regarding clinical and coding expertise. As we advanced our capabilities in this core product offering, we recognized this was an iconic solution that has been around since the 90s – which reminded us of the Rubik’s Cube – another, slightly more famous 90s icon. Maybe solving DRG Validation is not as fun as solving the Rubik’s Cube, but solutions for both continue to evolve into better, faster methods.

The white paper that follows takes a very complex challenge (DRG and Clinical Coding Validation) and illustrates how we can use algorithms, models, automation, clinical experts, and outside-the-box thinking to advance payment optimization and better serve the changing market needs. Just like super cubers continue to figure out how to expedite and simplify solving the Rubik’s Cube every year (4.86 seconds in 2022), CERIS will continue to ideate and improve solutions in DRG Validation and payment integrity in total.

We hope you enjoy the white paper!

Let's partner to a clear path to greater accuracy and cost savings.