MedcoDRG Medical controlling

Clinical coding audit is based on DRG (diagnosis-related group) system, that classifies hospital cases into groups that are clinically similar and are expected to use similar amounts of hospital resources. This classification was developed as a collaborative project by Robert B Fetter, Ph.D., of the Yale School of Management, and John D. Thompson, MPH, of the Yale School of Public Health (1). The system is also referred to as “the DRGs”. When used for payment, the amount per episode of care is fixed for patients within a single DRG category (based on average cost), regardless of the actual cost of care for that individual episode, but varies across DRGs.

In general, DRG payments are used for inpatient care services but are also frequently used for daycare and surgery services. Depending on the country, a number of exclusions may also apply, such as for expensive drugs and medical devices, high-tech interventions, transplantations, emergency care, psychiatry, rehabilitation and long-term nursing care  (2).
Healthcare providers are paid by insurance or government payers through reimbursements based on the DRG coding.

MedcoDRG supports patients, healthcare providers, health insurance companies, government payers in the European Union with:

  • up-to-date expertise on strategic and operational aspects of hospital controlling including 
  • clinical coding audit and DRG validation
  • all cases will be comprehensively examined for medical plausibility.

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