DRG Clinical Validation
Apply physician-led review protocols to reconcile diagnostic and procedural codes with the clinical narrative, proactively identifying unsupported comorbidities to align reimbursement with actual patient acuity.
Explore All Payor Services →
DRG Clinical Validation
High-Risk DRG Review
Prioritize high-risk DRG categories to systematically compare coded ICD-10 diagnoses and procedures against the objective medical record.
CC/MCC Substantiation
Evaluate documented CC/MCC indicators through standardized workflows to ensure severity markers are backed by objective clinical evidence.
Independent Physician Review
Deploy independent physician reviewers to verify that a patient’s documented clinical acuity objectively aligns with the assigned DRG severity level.
Ready to Strengthen Your Position?
Partner with MHMDAA's physician-led team to build defensible, evidence-based processes that withstand scrutiny at every level.