Rising Dispute: Clinical Validation Audits

About this episode

This episode discusses the rise and implications of clinical validation audits in healthcare.

The rise of third-party payer audits is no secret to healthcare professionals and facilities, but one type of audit has gained particular attention in recent years: the clinical validation audit. Clinical validation audits ultimately lead to a downgrade of a hospital’s diagnostic-related group (DRG) payment, but the process by which they reach that result makes them particularly curious. During utilization review, health plans make decisions about the patient’s care and, in the ca...

Topics covered

• clinical validation audits
• third-party payer audits
• healthcare professionals
• diagnostic-related group
• utilization review

Keywords

• clinical validation
• audits
• healthcare
• diagnostic-related group
• payer audits
• utilization review

Mentioned in this episode

Organizations: ICD10monitor, health plans, hospital

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