DRG clinical validation audits will begin in September for Medicare Plus Blue claims

EXL, an independent company that provides auditing support for Blue Cross Blue Shield of Michigan, will perform clinical validation and coding claim audits for Medicare Plus Blue℠ claims on inpatient hospital diagnosis‑related groups, or DRGs, beginning in September 2022.

The audits will review medical records to ensure claims were billed in accordance with coding guidelines and diagnoses were supported by documentation in the medical record. 

Be ready to share medical charts for review at the time of an audit. After an audit, EXL will send you a letter with the findings and information on how to request an appeal, if necessary.

The purpose of the clinical DRG audit is to:

• Confirm compliance with national coding guidelines.
• Ensure documentation supports diagnoses and procedures reported.
• Detect, prevent and correct waste and abuse.
• Facilitate accurate claim payment.

Questions?
Call EXL’s Customer Service number at 1-833-717-0378 if you have any questions.