Many health plans choose to bypass editing on inpatient claims due to their complexity—but this means they potentially spend millions of dollars improperly in this rapidly growing area. While inpatient claims editing is challenging, with the right technology and expertise in place, payers can execute DRG and other inpatient claim reviews more efficiently while minimizing provider abrasion. In fact, this can often be accomplished even without requesting the member’s medical record.

On the second episode of our Payment Integrity Insights podcast, Cotiviti’s inpatient claim review experts discuss:

• How to increase postpay review efficiency for inpatient claims while also moving to more prepay for increased savings
• How artificial intelligence-driven chart selection can target medical records with the greatest likelihood of returning value
• How postpay cross-claim clinical review and certain prepay review types enable accurate determinations without a medical record